HomeMy WebLinkAboutBLD21642 Pole Bldg - BLD Application - 3/11/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED'-/� _//-
PERMIT NO.- 1
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE C,4 L v---
PARCEL _ LEGAL _
NUMBER (�- llj DESCR. f�UiT
NAME MAILADDRESS CITY&STATE/ LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING (jam
CLASS OF NEW ✓ ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK L
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ. FT. GARAGE Gy 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 ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERSAFFIDAVIT 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
IDEP
REMENTS 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
NFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
NING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
NER DATE X BY / ✓� DATE,
FOR OFFICE USE ONLY
RTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO 3
HEALTH PUBLIC WORKS FEE
PLANNING I FIRE BUILDING PERMIT '5 D
D.O.T. BUILDING PLAN CHECK �-
SPECIALCONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE ,
APPLICATION ACCEPTED BY PLANSCHECK BY APPROVED�F/OR IS DANCE PERMIT VALIDATION
�� BY /� CASH CK MO TOTAL q/ C/)e
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