HomeMy WebLinkAboutGRD0382 - BLD Application - 5/28/1991 BUILDING PERMIT APPLICATION
i MASON COUNTY
DEPARTMENT of GENERTRVICES
426 W.CEDAR/P.O.BOX 186 SH SHINGTON 98584
4 F DATE ISSUED JaS /l
PERMIT NO. 3
OWNER N E MAILA DRESS CITY BSTATE ZIP PHONE
DIRECTIONS //�
TO JOB SITE d / r.. I T C&- e 9 /; 4
PARCEL LEGAL j
NUMBER f� CJQ ' DESCR. Tylf Is�ct� yrj�1��
NAM MAIL ADDRESS CITYBSTATE� ZIP PHONE LICENSE
CONTRALTO / g f vs a
USE OF
BUILDING
CLASS OF NEW ADDITION TALTERATION REPAIR MOVE REMOVE
WORK r /
WORK DESCRIBE / h C�S� 4 /ia raz
�(
1,,44Pal X
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE❑ CONDITIONING.
BASEMENT SQFt BEDROOMS PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS Ft BATHROOMS SEASONAL RES.❑ COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED❑DETACHED❑
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
1 CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGI TRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
RE IREMENTS 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 ONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
O AINING APPROVALWM THE BUIIDIN PARTMENT. APPROVAL FROM IHE BUILDING DEPARTMENT.
t-lWNER DATE / X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES NO
NO DEPARTMENT YES NO
BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING 901, FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
Agouc 0a, o.+4,,ct- SHORELINE
0 — tjj 7s tich e,-F, hn✓S'r C wL4A, (f", Cv.l S",) WOODSTOVE
A 3 1 G11) Vt44fn -h -D e- PLUMBING
Lj . �I/�� 00JN MECHANICAL
STATE BUILDING FEE
d.c� bf ��i c/f OD/✓ � 6
APPLICATION ACCEPTED BY PLANS CHECK Y APPROVED FQB ISSU CE PERMIT VALIDATION (]
�yr� BY -as�Ny� CASH MO TOTAL 3 y