HomeMy WebLinkAboutBLD22506 Mobile Home - BLD Application - 8/11/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUE
an&?h.oT PERMIT NO.aa'SQ
OWNER NA E MAILADDRESS CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE _ Ns
PARCEL LEGAL
NUMBER
CONTRACTOR NAME MAILADDRESS CI &STATE LICE ENO. ZIP PHONE
USE OF
BUILDING
CLASSF WORK NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE
WORK
BEDROOMS-A- DECKS CARPORT NOTICE
BATHROOMS SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
TOTAL SO.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
TOTAL SO.FT. FIREPLACE DETACHED ABANDONED FORA ERIODOF180DAYS TANYTIME FT RWORKISCOMMENCED.COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS OR
PERMANENT SHORELINE
SEASONAL
OWNERS 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 TION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIR 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 CO ORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAIN G APPROVAL FROM THE BUILDING DEPARTMENT APPROVAL FROM THE BUILDING DEPARTMENT.
X O ER DATE X BY
DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED
YES No YES No BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING( PLAN CHECK '
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
"— v SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY I PLANS BY APPROVED FOR ISSUANCE PERMIT VALIDATION
w/ A `&- I BY IV*- 'C11"dr CASH CK MO TOTAL