HomeMy WebLinkAboutBLD N/A Pole Bldg - BLD Application - 8/13/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAME MAILADDRESS CITY BSTATE ZIP PHONE
i33 49'5TS- 6130
DIRECTIONS 1
TO JOB SITE SQL e F
IC S T S 7')P. P 4 o &-ti-. �.e C F C P4 r rQ vq 161-� S�' �it C 4 oe a Lt
PARCEL I LEGAL
NUMBER /2 50 QQ/ DESCR. 4- �� � ��
ME AILADDRESS CITYBSTATE LICENSE NO. ZIP PHONE
CONTRACTOR I�f FID�5. fa , Co - d , Z2 S Zjp7z%elP. /3
USE OF
BUILDING QO �!4 /J�o fQ/ /%� i 'z�(/ -s" l7 - V/
CLASS OF NEW ADDITION ALTERATION R AIR MOVE REMOVE
WORK ✓ L/
DESCRIBE
WORK
BEDROOMS DECKS CARP OT
S ARATE PERMITS ARE REO IREAIPLUM NG EATING, ENTILATING OR AIR
BATHROOMS TOTAL SQ. FT GAR GE CONDITIO G.
NO.OF STORIES BASEMENT ATTA HED THIS PERMIT COMES NUL N OID IF W R R CONSTR CTI N A RIZED IS NOT
COMMENCED THIN 18 ✓ YS, OR IF CON TRU TI OR WO IS USPENDED OR
TOTAL SQ.FT. FIREPLACE DETA ED ABA Np D FO APE OD F 180 DAYS AT A Y TIM T W K I OMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERSAFFIDAVIT CO T A ORS AFFID VIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS E CONTRACTORS I CERTIFY THAT Ate TLY REGISTERE CO ACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHING I MWIA E OF THE ORDINANCE EQ IREMENTS REGULATING THE
REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE. WORK R,W I H PERMIT IS ISSUED AND WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH, NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMA TH R WI H.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. r-/ APPROVAL FR TH B DING DEPARTMENT.
X OWNE DATE TS X BY DATE______
FOR OFFICE USE ONLY
DEPARTMENT YES PPROVENo_ DEPARTMENT YES NO
BUILDING VALUATION C!
HEALTH PUBLIC WORKS FEE
PLANNING �� FIRE BUILDING PERMIT J
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
Ci% C MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATIO ACc�EPT D BY PLANS CHECK BY A P PVVV /IS7u,NCE PERMIT VALIDATIONf� 5/� JTOTAL: `L �.�� ' CASH CK MO