HomeMy WebLinkAboutBLD N/A Repair Walkways, Ramp and Float - BLD Permit / Conditions - 7/23/1991 I
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
v�&'O<.') `-- PERMIT NO.
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER Lake nmAL4�ii.Chl
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DIRECTIONS
TO JOB
,SITE �"j p/ace- Dn. /O e�� oe /A�c l
O L G
PARCEL 22 1-6 2 -000va LEGAL
NUMBER _ Z- -y I DESCR.
NAME MAILADDRESS Y&STATE 21P PHONE LICENSE NO.
CONTRACTOR s'
USE OF
BUILDING
CLASSWORK F NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE ,
WORK
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINEX 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.❑ 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❑DETACHED O
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 DEPARTM,E(NT. APPROVAL FROM THE BUILDING DEPARTMENT.
j7R�S1�dN'I _»S`,Q��/rNN1Nkr� C�u�7
X OWNE ATE _� ` 9� X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING _ . �9-yZ PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
�J �t SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY P S CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
0'— �-/y`f6-Z BY �y `�� CASH CK MO TOTAL