HomeMy WebLinkAboutBLD21773 Mobile Home Space 33 - BLD Application - 4/8/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED v
PERMIT NO. C72/ 7 7%3
OWNER NAM - MAILADDRESSsO� ^CITY&STATE �J ' ZIP H9MC-
14
DIRECTIONS TO JOB SITE i ISW44000,11 &3 a7,5 5-5&
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�PARCEL �
AL
NUMBER ��� � 0JD SCR ,(� i
CONTRACTOR NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
6 W,,c z i r 124 0 wA.
USE OF , /
BUILDING tom+-0 eh L;
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓ l/
WORK DESCRIBE 5L -r !.[ fytob ( l e Ao
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS �' TOTAL SQ.FT. GARAGE 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
TOTALSQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT�_ SHORELINE
SEASONAL
OWNERS FIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY AT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRAT N LA RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIRE NTS F 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 CON R E THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAIN GAP OVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
N TE _ �� X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
1
HEALTH PUBLIC WORKS FEE
PLANNING (1 FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP 3 PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHf4K
�BY APPROVED FOR ISSUANCE PERMIT VALIDATION ��, ��
�'t�+^-� BY ��f CASH CK MO TOTAL