HomeMy WebLinkAboutBLD0478 Repair Walkway Ramp and Float - BLD Application - 6/16/1992 •
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
Ca . Wh 97 276-
DIRECTIONS v
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TO JOB SITE _ Qt��t_Itio� M
t
PARCEL 2Z3 1-St1'-oGa39 LEGAL
NUMBER DESCR. j s �C� 3
NAME MAIL ADDRESS ITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR Sc�
USE OF
BUILDING
C WORK ORK NEW ADDITION ALTERATION REPAIR ✓ MOVE REMOVE
LASSr
DESCRIBE
WORK t 4 t
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.0 THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS S Ft BATHROOMS SEASONAL RES.❑ COMMENCED WITHIN 180 JAYS, 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 IS CARPORT/GARAGE
GARAGE SgFt ATTACHED U 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.
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X OWN E 4ji9tATE XBY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION p
YES NO YES NO 9r/D
HEALTH Iv PUBLIC WORKS FE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDINGGROUP - PRE-INSPECTION
_ 5 SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
ZIP
APPLICATION ACCEPTED BY P INS CHECK TOTAL �� 0HECKBY APPROVED FOR ISSUANCE PERMIT VALIDATION J
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