HomeMy WebLinkAboutBLD25299 SFR - BLD Application - 3/14/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED //V/- <�l
Q PERMIT NO.
NAME MAILADDRESS / CITY&STATE ZIP PHONE
OWNER r n/r c,(v O b A -1 a,' 95-z
DIRECTIONS � •
TO ECTIOJOB SI E �r r y _ r '0 T• UN !lK'_z.r= ,rl- -fc) L F1' ti Dr
-r6 it Lr-?tve fc la-t 1.2,ti CIVC C (Cy SQC
PARCEL j / LEGAL
NUMBER DESCR.
NAME MAIL ADDRESS CITY&S ATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW / ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r V/
DESCRIBE
WORK
BEDROOMS_ DECKS CARPORT NOTICE
N1 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE l CONDITIONING.
NO.OF STORIES _/_ BASEMENT Ab 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. I�� FIREPLACE A16, DETACHED ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME 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
REGISTRATII)N LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS 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 CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X BY DATE
X OW R DATE � ',? - L �
FOR OFFICE USE ONLY
APPROVED YEAPPROVED BUILDING VALUATION j�)�. �� U�
DEPARTMENT YES NO DEPARTMENT ,O
HEALTH a
PUBLIC WORKS FEE
PLANNING 1�)FIRE BUILDING PERMIT 2_ _r, �1
D.O.T. BUILDING , PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP _ yY\_L PRE-INSPECTION
, SHORELINE
'V
v WOODSTOVE
Tv PLUMBING �1-7) ,
MECHANICAL t'
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY�� F SSUANCE PERMIT VALIDATION TOTAL ' �d
BY CASH CK MO