HomeMy WebLinkAboutBLD N/A Garage - BLD Application BUILDING PERMIT APPLICATION
MASON COUNTY
DEP
ARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
OWNER -
DIRECTIONS
TO JOB SITE ----- -—
PARCEL EGAL } -
NUMBER -� �- ESCR. '2
AME MAIL ADDRESS CITY h STATE ZIP PHONE LICENSE '
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 U 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.U ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED❑DETACHED❑
OWNERS AFFIDAVIT I 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 M E EMP AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
RK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WO
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST APPROVRAL FROM THE BUIMANCE ILDING DEPART TH NO CHANES HALL BE MADE WITHOUT FIRST OBTAINING
MENT
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT.
/ ' J - --- —---
XOWNER 'DATE ____ ——__ X BY_ _ DATE —
FOR OFFICE USE ONLY
APPROVED APPROVED BUILDING VALUATION
DEPARTMENT YES No DEPARTMENT YES No
HEALTH PUBLIC WORKS FEE
PLANNI
NG
FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIALCONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION TOTAL
gY 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.
NAME ALADDRESS CITY&STATE ZIP PHONE
OWNER
w u
1
DIRECTIONS
TO JOB SITE
PARCEL LEGAL `
NUMBER "`;�j t uc DESCR
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.
j;
01 ► _
7.
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.
46
SIGNATURE OF OWNERS)OR AUTHORIZED 4EPRESENTATIVE
00 NOT WRITE BELOW THIS LINE
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