HomeMy WebLinkAboutBLD21374 SFR - BLD Application - 12/31/1987 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
t i ey_J T_ 7rS= ✓y 77•-400
DIRECTIONS
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PARCEL LEGAL
NUMBER I -L� ����_0 0/ DESCR. � vT �/y ✓1 ✓ Z /P� vCr 4 , I 1
CONTRACTOR NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
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USE OF
BUILDING
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CLASS OF NEW If .0011 WORK ADDITION ALTERATION REPAIR MOVE REMOVE
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DESCRIBE
WORK i�z I 3 v I c� T o
BEDROOMS_ DECKS AZ,9 CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS_ TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES 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 Sgt.FT. FIREPLACE G DETACHED ABANDONED FOR A PERIOD OF 180 DAYS ATANYTIME AFTER WORK IS COMMENCED.
PERMA ENT ✓ SHORELINE
SEAS AL > ,�
OW ERSAFFIDAVIT CONTRACTORS AFFIDAVIT
I CE TIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGI TRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQ IREMENTS 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 NFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBT INING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
O NER DATE X BY DATEZ 7- '� sue` S"?
FOR OFFICE USE ONLY
DE ARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION t'41
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT -5
D.O.T. BUILDING PLAN CHECK L �J
SPECIAL CONDITIONS BUILDINGGROUP PRE-INSPECTION _-----�
y7 ;7 SHORELINE
Cj�j t C G , J ' :21' WOODSTOVE
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PLUMBING Cx�
i MECHANICAL t CaC�
STATE BUILDING FEE
' STATE SURCHARGE 5 6)e
APPLICATION ACCEPTED BY P S m
A R ISS E PERMIT VALIDATIONY � CASH CK MO [TOTAL �)O