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HomeMy WebLinkAboutBLD0556 SFR - BLD Application - 7/28/1987 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 426-5593 DATE ISSUEDD��GG PERMIT NOL.. 5!T 42 NAME MAILADDRESS CITY&STATE ZIP PHONE OWNER trr� Kto L 'r r-A VJ-Z �pew+wrTar. iZ 7 _ooy DIRECTIONS R T- a TO JOB SITE rl " c.,.s I. ✓ t c o r. /V !� o v. z Q► 9' h r c R I c v h I I !. z H t PARCEL LEGAL JK i e r �, 1 1 D ✓ NUMBER [Z�:CI-.S�-0aC) DESCR.1 NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE CONTRACTOR © -70 zz sa I Z7 k TZ c.•► �s o,H ec y "6 00 USE OF BUILDING CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE WORK r DESCRIBE c WORK si ter., c" BEDROOMS— DECKS e-I CARPORT NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS/ 1-'t TOTAL SQ.FT. GARAG CONDITIONING. NO.OF STORIES L 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.Ix FIREPLACE e_ DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PERMANENT ✓ SHORELINE '-' SEASONAL 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. ,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS FOR WHICH IS 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 THER ITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING APPROVAL FRO THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. XOWNER DATE I XBY _— DATE FOR OFFICE USE ONLY 4FEE APPROVED DEPARTMENT APPROVED BUILDING VALUATION DEPARTMENT Yes No Yes NoHEALTH PUBLIC WORKS PLANNING FIRE BUILDING PERMIT D.O.T. I BUILDING PLAN CHECK /„�%. SPECIAL CONDITIONS I BUILDING GROUP PRE-INSPECTION /Q��-4s SHORELINE ( WOODSTOVE Off� (Fc 3 • D Q PLUMBING ,mod Ov MECHANICAL STATE BUILDING FEE �• STATE SURCHARGE ,Q PAPPLICATIONPTED BY P CHEC PPR OR I VALIDATION TOTALg qERMIT ASH CK MO