HomeMy WebLinkAboutBLD29397 Mobile Home - BLD Application - 10/24/1991 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.
a
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER x �- a AM$1 AUeAj 761 IfTCMIC' cJ WS -
DIRECTIONS �/
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CONTRALTO N� t � MAILADDRESS CITY&STATE ZIP �•7 PHONE LICENSE NO.
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
R w
A
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE IWSqFt STORIES f SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS 3 PRIMARY RES)< THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS $ Ft BATHROOMS SEASONAL RES.❑ COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
q ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED 0 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.
X O N ER DATE� 'o / X BY _ DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION J
YES NO YES NO 5-10
HEALTH �Q PUBLIC WORKS FEE
PLANNING Z FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDINGS PLAN CHECK --
SPECIAL CONDITIONS BUILDING GROUPS f `rr' 'L PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE JJ
i
APPLICATION ACCEPTED BY PLANSCHECKBY APPROVED FOR ISSUANCE PERMIT VALIDATION TOTAL
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