HomeMy WebLinkAboutBLD20945 Wood Framed Back Boards - BLD Application - 9/22/1987 1
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
PERMIT NO.
OWNER NAME MAILADDRESS CITY BSTATE ZIP 'MlSNC
DIRECTIONS /� / /
TO JOB SITE ' �', . -5/� .n (4_.c 7�i-�_ ci* C—
PARCEL 7r_ LEGAL GNUMBER j �� DESCR. / `�Y j (� 2- (.:; j- � � icC
NAM MAILADD�RyE--S-S /y CITY&STATE rtetmerQ0' ZIP PHONE
CONTRACTOR "f , '"
USE OF 1
BUILDING r^ ✓ R
CLASS OF NEW ADDITION ALTERATIOty REPAIR MOVE REMOVE
WORK ✓
DESCRIBE ((
WORK ��- Lv v c% r f; A e c. � / c c 1,e
/ Gc� c1�
\
7 'F i . t^ ��" .J C� ��—' ^ c.- -
BED OMS 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 1
SEASONAL 4 ' Z 1��^C'
OWNERSAFFIDAVIT CONTRACTORS AFFIDAVIT TC-,-5 - `-;> �> J
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 CgNFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAI ING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDIN f.DEPARTMENT.
r ?" �r"
X O NER DATE X BY DATE 2 2"
FOR OFFICE USE ONLY
DEP TMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING ( FIRE BUILDING PERMIT ev
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP At / PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE r
8 STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHEC APPROVED FOR I yJ PERMIT VALIDATION
1
�-' BYQ f , ` -7 CASH CK MO TOTAL �,