HomeMy WebLinkAboutBLD29262 SFR - BLD Application - 10/11/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.` ` t '-
—
OWNER NAME MAILADDRESS CITY BSTATE ZIP PHONE
DIRECTIONS
TO JOB SITE / d 4 T{ �,/ 2. e1 ►, c7 /� Ij�/ 't� f/~ /�. fi !md ,� ,Jt..J+r,r r ,C !'
i
PARCEL LEGAL h. I J i -J tin 7z
NUMBER � ��
CONTRACTOR
NAME MAILADDRESS CITY BSTATE LICENSE-NO. ZIP PHONE
.��? ��6-9
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE WORK REMOVE
DESCRIBE n
WORK -5 ! ri z' 2 �Z vs f'^C ! : ! �. �' ✓ .3
BEDROOMS ! DECKS CARPORT NOTICE
BATHROOMS TOTAL SQ.FT. GARAGE /�U SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
LZ / 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 SQ.FT. ! FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME 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
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.
X OWNER DATE X BY DATE '
FOR OFFICE USE ONLY
DEPARTMENT APPROVED NO DEPARTMENT APPROVED
YES YES NO BUILDING VALUATION
V
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT T 3
D.O.T. BUILDING PLAN CHECK �b
SPECIAL CONDITIONS BUILDING GROUP , PRE-INSPECTION
SHORELINE
10 = , Fj�) WOODSTOVE
s+� PLUMBING 1
MECHANICAL
zJ 1"]to "J STATE BUILDING FEE C jh
�Q STATESURCHARGE `
APPLI //T]]ION ACCEPT jSN:S CHECKBY APPROVED FOR ISSUANCE PERMIT VALIDATIONL BY k�-I `�� CASH CK MO TOTAL I U�