HomeMy WebLinkAboutBLD110191 Storage - BLD Application - 11/1/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED ( tG��
PERMIT NO. I 0'Cl I 1)K-
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
d 3730 71/-� `I6
DIRECTIONS
TO JOB SITE Q. - i' i cn -T c,
PARCEL LEGAL
NUMBER ��3iD -7YrosOr DESCR.-Se>L, 10 %s° N Al,
CONTRACTOR
NAME MAIL ADDRESS CITY&ST E IP PHONE LICENSE NO.
�
USE OF
BUILDING �1_1.AlA�
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE
WORK �STO C L'
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE/ 3�)y SgFt STORIES f SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS S Ft BATHROOMS SEASONAL RES.0 COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
g ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE /V IS CARPORT/GARAGE
GARAGE SgFt ATTACHED 0 DETACHED❑
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
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS 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
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT,
X OWNERo6'l,- DATE l D 30- X BY _ DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVEDJO DEPARTMENT YES DEPARTMENT BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
- - - SHORELINE
WOODSTOVE
~ - L PLUMBING
MECHANICAL
) Z— t Z_ STATE BUILDING FEE
APPLICATION ACCEPTED BY PLANS CHECK B�) APPROVED FOR ISSUANCE PERMIT VALIDATION
I - I 'I � BY � � CASH CK MO TOTAL