HomeMy WebLinkAboutBLD29922 Pole Bldg - BLD Application - 2/10/1992 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED n S
PERMIT NO. V
NAME MAIL ADDRESS CITY d STATE ZIP PHONE
OWNER lJ E R�/'l /i4 R CR �/� �/ Ja/`� t S=
DIRECTIONS Vl:F ,4TO R O j>
TO JOB SITE
1Nwj' 3 �o /�EtG/'�ii�,' vcO geGr'[iiQ y�� T/ gr"A/1 CR,
PARCEL LEGAL
NUMBER (f -47QQ7 Q DESCR.I; eE ,4�7/.► ED
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR L d-ria Pas, 171Y LA0444A wWO, /fAK'0 /1 AZz BLS"-»6
USE OF
BUILDING G R/46rE
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK QL
BEDROOMS DECKS CARPORT NOTICE
j.. SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SO.FT. GARAGEJR L CONDITIONING.
NO.OF STORI ES 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.
-4 X OWNER DATE X BY ✓� bATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVE NO DEPARTMENT YESPPROVENO BUILDING VALUATION J
HEALTH , PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT D
D.O.T. BUILDING PLAN CHECK 5�
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION G
GA BY � CASH CK MID TOTAL ✓� G