HomeMy WebLinkAboutBLD27743 Mobile Home - BLD Application - 3/25/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER N E - IL ADDRESS CITY&STAY ZIP P ONE
DIRECTIONS
TO JOB SITE
PARCEL ^ LEGAL
NUMBER DESCR.
ME MAILADDRESS ITY&ST E F O. ZIP PHONE
CONTRACTOR /�8 C
�ficaw
USE
BUILDING 6
CLASS OF NEW Q� ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓ v
DESCRIBE
WORK
BEDROOMS DECKS Y OR N CARPORT NOTICE
TOTAL SO.FT.
IECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SO.FT. TOTAL SO.FT. CONDITIONING.
NO.OF STORIES -1- BASEMENT Y R N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA BASEMENT COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. TOTAL SQ.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT FIREPLACE 1ATTACHED / ' 4
�^ ' A
HORELINE ( Y1�1�(j( N ( � I► ►d1�(v�
DETACHED
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CER Y THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGI RATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY.ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQ REMENTS 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 CH G ALL BE MADE WITHOUT FIRST OBTAINING
O AINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUI NG M T.
OWNER DATE XB DATE
FOR OFFICE U ONLY
APPROVED APPROVED f
DEPARTMENT YES No DEPARTMENT YES NO BUILDING VALUATION Q
HEALTH 4 PUBLIC WORKS FEE
01
PLANNING FIRE BUILDING PERMIT 0-
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE.INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
�� IV CASH CK MO I
TOTAL