HomeMy WebLinkAboutBLD26205 SFR - BLD Application - 7/18/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO. CIAO
11
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
DIRECTIONS , I
TO JOB SITE i�t�
PARCEL LEGAL
NUMBER DESCR.
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR A.cK ��c�.�. ,���-m, r•s
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE
WORK -r m l'p/'<cvL_ —r1=
BEDROOMS y� DECKS YOR N CARPORT rr NOTICE
TOTAL SO.FT.
'jam DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS
TOTAL SO.FT. Z� TOTAL SO.FT. CONDITIONING.
NO.OF STORIES BASEMENT Y OR N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA BASEMENT COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. TOTAL SQ.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT v FIREPLACE _� ATTACHED
SEASONAL SHORELINE b 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
REGIST TION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQU MENTS 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 NFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
O AINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER'$l9,4 9 DATE X BY DATE—
FOFfOFFICE USE ONLY
DEPARTMENT YESPPROVENo DEPARTMENT YESPPROVENO BUILDING VALUATION Z a0 v
EALTH PUBLIC WORKS FEE
PLANNI FIRE BUILDING PERMIT CC)
D.O.T. BUILDING PLAN CHECK C a
SPE IAL CONDITIONS BUILDING GROUP ,♦-A PRE-INSPECTION
SHORELINE
WOODSTOVE C v
OR EXCecD LOCALL CO UST Es IF a Ny PLUMBING
OFFICE BEFORE CO STLL THIS t MECHANICAL
22. C"
STATE BUILDING FEE L
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPF ISSUANCE PERMIT VALIDATION 50� O
�' ! BY CASH CK MO TOTAL