HomeMy WebLinkAboutBLD N/A Garage - BLD Application 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 MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER
DIRECTIONS
TO JOB SITE _ ---
PARCEL _ �ZD
GAL : }—� �- �--
NUMBER �'a /` ESCR. G' /c,c_ { �_L
NAME MAILADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE /
WORK
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
COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
DECKS SgFt BATHROOMS SEASONAL RES.❑ ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED Cl DETACHED❑
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 O CONFORMANCE FROM THE THERBUILEWITH,
NO CHANGES DEPARTMENT.ALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT.
" 1
X OWNER DATE -- X BY--- ----- ---- DATE -----
FOR OFFICE USE ONLY
APPROVED APPROVED BUILDING VALUATION
DEPARTMENT YES NQ DEPARTMENT ves No
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE71 PERMIT VALIDATION TOTAL
BY CASH CK MO
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAM-E LADDRESS CI 8 STATE ZIP PHONE
OWNER VV
DIRECTIONS
TO JOB SITE
PARCEL LEGAL
NUMBER DESCR. zo.
Indicate below. O Property lines and dimensions.
O Easements and roads
O Septic, drainfield and reserve area, or sewer.
O Septic tank and drainfield setback distances from foundations
O Location of proposed construction on property.
0 O Building& septic system setback distances from all property lines& easements
Indicate North O Well and water line.
O Saltwater, lakes, rivers, streams, wetlands, drainage.
In Circle O Attach copy of septic system"as built" or septic permit approval.
O Indicate topography profile of property and structure on reverse side.
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71
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I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without first obtaining approval.
SIGNATURE OF OWNER(S)OR AUTHORIZED EPRESENTATIVE
00 NOT WRITE BELOW THIS LINE
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