HomeMy WebLinkAboutBLD26383 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 Na�&
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
r * T L oa. r O ntit/—r-
DIRECTIONS
TO JOB SITE 7' / Z ro hlAs tq, -r r•
IV Lw /C r 1%, /✓,v Ao% r p ►. Q a ✓ CI �� /l L e,r► C
PARCEL LEGAL A �v t It s / �i ✓ Z
NUMBER / -57 oop� DESCR. o r :ow Z
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR rtN _ 0#" LZ 5cs61—K 377"�G��
USE OF
BUILDING rQ
WORK O✓ NEW i/ ADDITION ALTERATION REPAIR MOVE REMOVE
CLASSDESCRIBE
WORK
BEDROOMS - DECKS YOR N CARPORT NOTICE
TOTAL SQ.FT.
BATHROOMS Z DECK GARAGE SEPARATEPERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
TOTAL SQ.FT. �V TOTAL SQ.FT. CONDITIONING.
NO.OF STORIES BASEMENT Y OR N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA �j�/ BASEMENT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. / Y�l TOTAL SO.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT FIREPLACE ec ft ATTACHED
SEASONAL SHORELINE DETACHED
OWN ER§IAFFI DAVIT CONTRACTORS AFFIDAVIT
I CERT THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGIS ATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQU EMENTS 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 NFORMANCE 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 DEPARTMENT.
WNER DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO ��S O, 0
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT Q
D.O.T. BUILDING r PLAN CHECK U
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
ME'V SHORELINE
WOODSTOVE v
PLUMBING 3
MECHANICAL P7. d U
STATE BUILDING FEE
STATE SURCHARGE
'OLICATION ACCEPTED BY PLANS CH CK/BY f� APPROVED
FOR ISSUANCE PERMIT VALIDATION
�k y/6--Q� r��=�'�" BY JL�'�9 CASH CK MO TOTAL