HomeMy WebLinkAboutBLD0180 Bulkhead - BLD Application - 9/26/1989 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 91��
427-9670 DATE ISSUED /
PERMIT NO. 12
NAME MAILADDRESS CITY&STATE ZIP �Vhf9NE►
OWNERGe, _ P 0 Z'2. 4 - r4&11ILJ 9tgS-Z
DIRECTIONS
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NUMBER 1-Z 2)1- looll3 IDESCR.
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^�--NAMEr MAILADDRESS CITY&STATE Li9E#i6EMA. ZIP PHONE
CONTRACTOR J eSc3`�e vrs 1 — v� t� S� - 3e << ! (.0 28- -7 - B
USE OF � }
BUILDING 5xl)rL �•'�r e_ C C)S'-0rt C Odi�rd �- ��� a cFay+ . / PYS r�aP•�tG
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE / �/�
WORK 170 �,� Gel O /T �/'I' v� L $� y
u- t v`C -�•//
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE 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 c:e- .tc 6-S Cj-1 Z2 g j0 (�
OWJESAFFIDAVIT CONTRACTORS AFFIDAVIT
I CETHAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGITION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQENTS 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 CRMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTGAPPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
tXR E X BY�x DATE
FOR OFFICE USE ON L
DEPARTMENT YES APPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK / <
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE 44,50
STATE SURCHARGE
APPLICATION ACCEPTED BY I PMSBY APPROVE FOR IS E PERMIT VALIDATION
BYf-r- CASH CK MO TOTAL 5- 7 5