HomeMy WebLinkAboutBLD0638 Attached Garage - BLD Application - 4/5/19881
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO. e`*`4- 5 O
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
C C i
DIRECTIONS
TO JOB SITE L ILL, 1,0 Lgeswj villid,
LIB � 1 o 1�ILL- • E 0e. �'97d������ �/c;'a✓
PARCEL LEGAL �nJ � / p
NUMBER I;UD n 0000 Z DESCR. /Jc°Ct►`c�$ l�t^VP +✓�J, d koOt 2 �I�I.%. � 70
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
USE OF I /
BUILDING CTaraeic a l 1 w�c�04 10 1, k- c �p
CLASS OF NEI d ADDITION ALTERATION EPAIR MOVE REMOVE
WORK
DESCRIBE
WORK t n ,0L a ac iz
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES 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 ANYTIME 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
REGIS RATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUI IEMENTS 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
OBTAI JING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
NER DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING 1C, FIRE BUILDING PERMIT r S 0
D.O.T. BUILDING ", '�j PLAN CHECK
(�
SPECIAL CONDITIONS BUILDING GROUP 41 PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLIC O EPTED BY PLANS�HEC�K,BY APPROVED FOR ISSUANCE PERMIT VALIDATION /����
BY 71 CASH CK MO TOTAL