HomeMy WebLinkAboutBLD27401 SFR - BLD Application - 1/25/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NA E MAILADDRESS CITY&STATE ZIP PHONE
.-7
DIRECTIONS - //
TO JOB SITE "FJJ k p��✓ `, ` ,v A zv'v"1 .f i
PARCEL LEGAL
NUMBER 1z3rR1JY/QD�/�ih� DESCR. �07�" �� f lJ�ftr��f/
AME MAILADDRESS CITY&STATE I IP PHONE
.CONTRACTOR
USE OF
BUILDING
CLASS OF NEW �/ ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
BEDROOMS_ ? DECKS A 1 6' CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS. 49 TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES -,L BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. $ FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT . SHORELINE
SEASONAL
OWNER AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTI THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGIST ATION 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
IN C FORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTA ING APPROVAL FROM THE BUI G DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
Wiz DATE �'� -3;V X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION ry
YES N O YES NO 3 ,ov
HEALTH PUBLIC WORKS FEE
If
PLANNING FIRE BUILDING PERMIT ?G Q
D.O.T. BUILDING PLAN CHECK S p0
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
(��2. VYIVJ 1 t s I wv lW L-IA 4- WOODSTOVE
PLUMBING j, O C)
MECHANICAL
STATE BUILDING FEE cl
STATE SURCHARGE
APPL ION ACCEPTED BY PLANS CHE BY APPROVED FOR I DANCE PERMIT VALIDATION j
TOTAL
orky BY CASH CK MO