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HomeMy WebLinkAboutBLD29597 SFR - BLD Application - 11/22/1991 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT Of GENERAL SERVICES C� 426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584 427-9670 DATE ISSUED OWNER NAME PERMIT N . MAIL ADDRESS CITY 8 STATE r, W t- ZIP PHONE DIRECTIONS R _ oY TO JOB SITE ©u T 4 �1 a.� 3C/ z!r uJ WI T g `^ c c✓E'i r /- T A 7- a r� PARCEL NUMBER LEGAL t �.3.2 S/ -4C�o o tom, DESCR. / X ¢ Z NAME � 0 -7' CONTRACTOR T MAIL ADDRESS CITY&STATE I e�f I� f-f0 rYl .L C ZIP PHONE JilZ.fds.� /�� LICENSE NO. USE OF 7�/ 6' BUILDING � lK CLASS OF WORK r NEW ✓ ADDITION ALTERATION REPAIR DESCRIBE MOVE REMOVE WORK n / J Z G 7-- AREA: NUMBER OF: PLEASE INDICATE: NOTICE RESIDENCE p SgFt STORIES SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR SHORELINE❑ CONDITIONING. BASEMENT,Uj�ttSgFt BEDROOMS PRIMARY RES. DECKS SgFt BATHROOMS COMMENCED THIS PERMIT BWITOHINS180 NULL DA SD ORVOID IF CONSTRUCTION OR WORK AUTHORIZED ENDED NOT OR __ SEASONAL RES.O ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. CARPORT SgFt FIREPLACE IS CARPORT/GARAGE GARAGE D SgFt ATTACHED W ETACHED 0 OWNERS AFFIDA CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEM ROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRATION LAW RCW 18.27,A AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND 1 AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS FOR WHICH THIS PER 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 SHAL L S C NOES BE MADE WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING D ES HAL CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. XOWNER DAT X B DATEf O DEPARTMENT APPROVED FOR OFFICE USE ONLY DEPARTMENT YES NO YESPPROVENO BUILDING VALUATION HEALTH PUBLIC WORKS 151 PLANNING FIRE MARSHAL FEE D.O.T. BUILDING PERMIT BUILDING PLAN CHECK S SPECIAL CONDITIO 11 NS 11, r- BUILDING CROUP PRE-INSPECTION � v 41 n 15 SHORELINE a/4 D WOODSTOVE 3 PLUMBING O MECHANICAL • STATE BUILDING FEE G� APPLI TION ACCEPTED BY NS HECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION BY.I -2 I CASH CK MO TOTAL l� Q