HomeMy WebLinkAboutBLD26733 SFR - BLD Application - 9/18/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 r
427-9670 DATE ISSUED /
PERMIT N . '0el/ 17n---'�—
NAME MAILADDRESS CITY&STATE ZIP•OfI PHONE 90
OWNER 21
11 S'-G zd�ts' fie /�roiv -s g -
DIRECTIONS
TO JOB SITE
PARCEL LEGAL
NUMBER DESCR. /
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
OtJ v✓�
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
BEDROOMS DECKS OR R N CARPORT NOTICE
TOTAL SQ.FT.
DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. !ZO TOTAL SQ.FT. �ZO CONDITIONING.
NO.OF STORIES BASEMENT YOFO 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 SQ.FT. TOTAL SQ.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT X FIREPLACE 4/0 ATTACHED
SEASONAL SHORELINE _-h __ DETACHED
OWNERS AFFIDOIT CONTRACTORS AFFIDAVIT
I/CONFANCE
AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
RW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
ROR 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
ICE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OOVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
TE !r<-l7 '1�D X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION qq
YES NO YES NO St> Q b v
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT 8� On
D.O.T. BUILDING PLAN CHECK s' QO
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING �3, O 2y
MECHANICAL 2 p b
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY PLAN C Bi ^ APPROVED FOR ISS NCE PERMIT VALIDATION
TOTAL
BY CASH CK MO