HomeMy WebLinkAboutBLD0536 SFR - BLD Application - 5/26/1987 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
PERMIT NO. '51t 3
NAME MAILADDRESS CITY BSTATE ZIP PHONE
OWNER Jc�'r y ►�<< �j
G z 1 3 3 o K.TS z W 2 31 c Ph rte A^ Ld 2., c% L 3 77
DIRECTIONS (1v i a �G 1 �� r �" o r• c9 t d e t �: r �^ R� d. R lS I., T- o �^ ti+ewrlrrK
TO JOB SITE
RA. L c' 1 d R Gr 14, r � 3
PARCEL LEGAI 7V.,
NUMBER DESCR. /,t; / 4 o T ; 3
NAME MAILADDRESS CITY BSTATE LICENSE NO. ZIP PHONE
CONTRACTOR ?C ZZ s o I z T``
irztiK ZS ,cam uJz. SUM
USE OF
BUILDING $► �+9 e l�z'^^ ' I.� e S r c
CLASS OF NEW ✓ ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBEv� 1
WORK cS I hJ, 2 1=2�•,•• i 1 R z r-. i e r y T'o
1 Z. r" r S I
BEDROOMS 3 DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS %� TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BASE .1NT 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 SO.FT. FIR LACE GS DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT S ORELINE
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW R 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS FOR W CH 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 T REWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVA ROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OW ER DATE X BYL DATE
FOR OFFICE USE ONLY
DEPARTMENT Y SPPROVED�O DEPARTMENT YEAPPROVEDIO BUILDING VALUATION (�/ j 5 p d
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK ,�✓r �' O
SPECIAL CONDITIONS BUILDINGGROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL 9;
STATE BUILDING FEE
STATESURCHARGE v /)
APPLICATION ACCEPTED BY I PLANS CHECK B� APPROVED
r�FOR I UANCE PERMIT VALIDATION
�� BY. G' CASH CK MO_'_TOTAL