HomeMy WebLinkAboutPre-Inspection to Determine Setbacks - BLD Application - 12/5/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED I
PERMIT NO.
F, `/ ��'JX�'(� �) MAI D �jITY&STATE ZIP PHONE
OWNER '� (, ,%2���%f 697,2s 2Cf� Ug-ml� ���. z
DIRECTIONS "L
TO JOB SITE /gyp
PARCEL .�Z3zY r� �Gll a Al NUMBER 7'
CONTRACTOR DESCR `
s rR i� a s
NAME MAILADDRESS CITY&STATE ICENSENO. ZIP PHONE
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓ y ,
DESCRIBE
WORK - (J
s
"ev C'
B 00 S DECKS CARPO NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROO TOTAL SQ.FT. RAGE CONDITIONING.
JC
NO.OF STORIES SEMENT 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
TOTALSQ.FT. FIREPL DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED,
PERMANENT SHOR NE
SEASONAL
OWNERS AFFIP14IT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROV THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27(E�1'9
AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS FOR WHICH ITIS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANC THER 1O CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAININGAPPR AL FR D�ING�DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
XOWNER �vV DA E � � � XBY_ _.DATE _
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
l� r! WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
IBY CASH CK MO