HomeMy WebLinkAboutBLD27647 SFR - BLD Application - 3/11/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 f
427-9670 DATE ISSUES /�
PERMIT NO. l0 C7
NAME J or r LL.MAILADDRESS CITY&STATE ZIP PHONE
OWNER e-L! T j r, s z �.,.vr c., t -?R5J L --377 c'�'`t f�
DIRECTIONS
TO JOB SITE ✓ i >e t1 -+ �" d v. /� �/ 2 • r .�/ /-7 v z:v k K
PARCEL LEGAL Pit , r ► ! .�1./ s Z
NUMBER /z -i -5-1. �voQc( DESCR. G
40 7' 0-
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR rsnl; T�.,� �.7�'i* �''= =sir-i u .r�7. -r✓ Y3i L71-/L LSD
USE OF
BUILDING
CLASS OF NEW ✓ ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK J✓'1 K �� �` � s /� ��. c c
e,
BEDROOMS 3 DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE !Y`t'`' CONDITIONING.
NO.OF STORIES t__ BASEMENT 5 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./'ZA_�tl_J FIREPLACE -5-S DETACHED ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE PO
SEASONAL sfi
OWNERSAF DAVIT CONTRACTORS AFFIDAVIT
1 CERTIFY T T I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATI LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIRE TS 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 CONE MANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINI APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER DATE X BY DATE-/5 l
FOR OFFICE USE ONLY _
DEPARTMENT APPROVED DEPARTMENT YEAPPROVEDIO BUILDING VALUATION
YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. I BUILDING ` PLAN CHECK a J
SPECIAL CONDITIONS BUILDING GROUP ^. L;.-1 PRE-INSPECTION
SHORELINE
WOODSTOVE V 6—
PLUMBING
-1.'- c4 MECHANICAL
-7. ,�i,, !` l,,` STATE BUILDING FEE
c ' STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY � V�R ISSUANCE PERMIT VALIDATION TOTAL ��- /
�I BYE CASH CK MO ��
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