HomeMy WebLinkAboutBLD29616 Carport - BLD Application - 11/27/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME r^ I M L ADDRESS CITY&STATE ZIP PHONE
OWNER Z[
DIRECTIONS
TO JOB SITEPARCEL LEGAL
�� , , y LtG C� ��<� �� ✓� /�� 'G 6 v
NUMBER :j 20 " 2 ESCR. S/ 5 Za l- 7_x �,F'
NAME MAIL ADDRESS ____cITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR L vS c}/7/� f�� �r �� • Gc - _ rSi
USE OF V_ cri7 Z
BUILDING
WORKF W NEW t/ ADDITION ALTERATION FREPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK �/
C!0 ft �,Z �
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS S Ft BATHROOMS SEASONAL RES.❑ COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
g ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT YJ SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED❑DETACHE
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR CH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH, NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORM C THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROV DING DEPARTMENT.
XOWNER DATE _ XBY _ ATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVENo DEPARTMENT YESPPROVENo BUILDING VALUATION qL}��
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT ,�' %
D.O.T. BUILDING PLAN CHECK C'
SPECIAL CONDITIONS BUILDING GROUP _ PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE S 1
A LICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
By
J" / CASH CK MO TOTAL
I