HomeMy WebLinkAboutBLD26363 SFR - BLD Application - 8/3/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO,r,�yJP�/
�1L J
OWNER NAME ` MAIL ADDRESS CITY&STATE ZIP PHONE
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DIRECTIONS
TO JOB SITE L't-013LLF4"4 �► ` f, u 3r �rha�Tv /►9��C' ��GhT7,/� GU^ N6jjj<1Rtc.
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PARCEL I LEGAL
NUMBER 5-1 OOOc 6 1 DESCR. 7_P_4C ,6 vi✓Z- Ra bf-[.H96rZ (LIA
CONTRACTOR NAME4r ' MAIL ADDRESS CITY&STATE SE NO ZIP PHONE
USE OF
BUILDING N 6/ lam✓} ml I 4X A& S/_oLzlvC L _
WORK CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE
WORK AU._ R U r c)Ls n gc)i i_plr"6 4 C7"T-
BEDROOMS __ DECK Y�IDR N CARPORT NOTICE
TOTAL SO.FT.
BATHROOMS-2- DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
TOTAL SQ.FT. c)c TOTAL SO.FT. �_.7 CONDITIONING.
NO.OF STORIES _ C - BASEMENT Y ORIE1 THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA / BASEMENT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. ( TOTAL SQ.FT. _- CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT-*
FIREPLACE ATTACHED
SEASONAL � __- SHORELINES DETACHED - N
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
REQUI MENTS 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
N C AS
THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBT INING APPROVAL FROM THE BUILDING DEPARTMENT, APPROVAL FROM THE BUILDING DEP RT T.
V
OWNER DATE XBY DATE
FOR OFFICE USE OP&Y
APPROVED APPROVED
DEPARTMENT YES No DEPARTMENT YES No BUILDING VALUATION ( c� L{�
HEALTH 67 PUBLIC WORKS FEE
PLANNING FIRE
BUILDING PERMIT
D.O.T. BUILDING �� -�
(L L, PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
pp _ SHORELINE
WOODSTOVE C�
C ( PLUMBING c
MECHANICAL iCI c. 1
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY AP VED ISSUANCE PERMIT VALIDATION
B CASH CK MO TOTAL ��