HomeMy WebLinkAboutBLD28343 SFR - BLD Application - 6/12/1991 'BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED' '/02
PERMIT NO.o?ffL- ��
NAME .j jQL! MAILADDRESS CITY B.STATE ZIP PHONE
OWNER /�oz 1 T 3v KaTsz w,. 3rcnlcrTv� �.✓><. fr3/ z. j77'e-y
DIRECTIONS
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TO JOB SITE v T' c �� � a.� �-' �-. l �-- �� z� `
i r K 4 i O
PARCEL _ LEGAL tq&✓ '� Z
NUMBER /Z7 2/�3 /-��<O DESCR. 11-0 Tr t/0
NAME MAILADDRESS CITY BSTATE LICENSENO. ZIP PHONE
CONTRACTOR r- �cxiyaxw
z�/Z-Z y � � 3r¢�ar�i�'�s� J�' 377
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK 77 v i cl
BEDROOMS -_ DECKSaR N CARPORT NOTICE
TOTAL SQ.FT.
DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS Z TOTAL SO.FT.ll_Q _ TOTAL SQ.FT. l7 CONDITIONING.
NO.OF STORIES -_- BASEMEN-16OR N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA BASEMENT COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
y 6
TOTAL SQ.FT./I TOTAL SO.FT.�_ L CHECK ONE ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT FIREPLACE ATTACHED
SEASONAL SHORELINE DETACHED
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 18.27,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.
XOWNER DATE XBY,4 � C/
DATE '7�- /SS /
FOR OFFICE USE ONLY
APPROVED DEPARTMENT APPROVED BUILDING VALUATION V
DEPARTMENT YES No YE NO
HEALTH PUBLIC WORKS FEE
gla
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK -�
SPECIAL CONDITIONS BUILDINGGROUP PRE INSPECTION
SHORELINE
WOODSTOVE 1J
PLUMBING
MECHANICAL
STATE BUILDING FEE Z71 J
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY AP V OR ISSUANCE PERMIT VALIDATION TOTAL
CASH CK MO