HomeMy WebLinkAboutBLD26734 SFR - BLD Application - 9/18/1990 ---------------
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 /
427-9670 DATE ISSUED
PERMIT NO. 17
OWNER NA E MAILADDRESS CITY BSTATE PHONE�gB
DIRECTIONS
TO JOB SITE
PARCEL LEGAL ,�
NUMBER DESCR. �p7 /vim-'���/ �l1it/off
N ME
CONTRACTOR MAIL ADDRESS CITY 6 STATE LICENSE NO. ZIP PHONE
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK cv �O ' ST
BEDROOMS r DECKS Y R N CARPORT NOTICE
TOTAL SQ.FT.
BATHROOMS Z DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
TOTAL SQ.FT. /OO TOTAL SQ.FT. EGG 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 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SO.FT. TOTAL SO.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT_ FIREPLACE ATTACHED
—
SEASONAL SHORELINE DETACHED
OWNERS AFFID VIT CONTRACTORS AFFIDAVIT
1 CERTIFY THAT AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION W RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENT 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 CONFOR NCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING PROVAL FROM THE BUILDING DE.P TMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNE E X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES APPROVED DEPARTMENT YES No
BUILDING VALUATION
5.7 29 ,oo t.
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDINGGROUP ..J PRE-INSPECTION ,
SHORELINE
WOODSTOVE
PLUMBING G
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE '
APPLICATION ACCEPTED BY PLANS C K BY APPROVED FOR I ANCE PERMIT VALIDATION
TOTAL
BY CASH CK MO