HomeMy WebLinkAboutBLD21383 Deck - BLD Application - 11/16/1987 BUILDING PERMIT APPLICATION
C'� �C MASON COUNTY
�v DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED/ �'
Z PERMIT NO.�k_Y � .?
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
�
OWNER ',f ' s .2 -.,
DIRECTIONS `
TO JOB SITE
NUMBER
✓� lJ DESCR ,.S/,' C:,
/� .
NAME MAILADDRESS CITY&STATE LICENSE NO ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW t/` ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK L e � 4° 7reL�
:&
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.F 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 FORA PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CE 1IFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGI 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 1EMENTS 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 C NFORMANCE 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.
XO ER� � i2ztw✓ ,DATE �d� __ � XBY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION 114 �C
YES NO YES NO �•
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT: ,`
D.O.T. BUILDING PLAN CHECK ,-775
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
( 0 , SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY Y FOR ANC PERMIT VALIDATION
TOTAL
C BY ASH CK MO