HomeMy WebLinkAboutBLD22341 Pole Bldg - BLD Application - 7/15/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO. �/
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
J J
DIRECTIONS
TO JOB SITE
. .3 G Q 5 Alq a.
PARCEL LEGAL I
/
NUMBER -____'- DESCR.
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTORAL s1,7Z9fCaZF //,AS 1
USE OF
BUILDING IN
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK
1 �(
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
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 WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OW ER DATE X BY � � �"'""" DATE'S �—
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION rj`rl cl
YES NO YES NO �
HEALTH �t✓r!� PUBLIC WORKS FEE
PLANNING t,+l� FIRE BUILDING PERMIT ��� �C i
D.O.T. BUILDING 4UK PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP P �? PRE-INSPECTION
SHORELINE
LUet WOODSTOVE
PLUMBING
_ ? C MECHANICAL
STATE BUILDING FEE '
STATE SURCHARGE
APPLICATION ACCEPTED BY PLLA�NSICHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
BY U� CASH CK MO