HomeMy WebLinkAboutBLD0410 - BLD Application - 7/30/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.4:2 V10
OWNER NAME MAILADDRESS CITY BSTATE ZIP PHONE
HAFFEaTY M icmo. 1555 4ugjA My W SAt+'rrA g WA 981" W—
DIRECTIONS
TO JOB SITE OFF Roum 3 ON To G44mvi,Ety kpao Rmp.-Aym&xjEozr j%w Om7o �Fmfix*L74;
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PARCEL
NUMBER 121�+0 �1 0��8 D SCR. �-OT �� ArOF VIVF.-
YA&ACOVE
NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE UCENBE m
CONTRACTOR JisFIe"w4rce P102663, &-A4jx wpc 98am 27'1-468+ JESF 11
USE OF
E"51OW C-vP4rim L HEAD
BUILDING
CLASS OF NEW X ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE �+ �L
WORK COnlSTQwcvaN OF APl30ot L.,F, a94p /f 64 JFE/NfDJ�a Cbkwz. ,7v Zuwa#6yD
ANv Wt N G W^.� Peuc L'�AW,N Gs. (78' , Ap - 7 ` %V i,4a WAIL
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE O CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS Ft BATHROOMS SEASONAL RES.O COMMENCED WITHIN 180 SAYS, 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 0 DETACHED❑
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS 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 CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
XOWNER DATE XBY DATE 6- 2' •91
jr u
FOR OFFICE ust6N LY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
` PLUMBING
i® MECHANICAL
�� STATE BUILDING FEEJVI
APPLICATION ACCEPTED BY PLANSCHECK BY APPROMDFISS��PERMIT VALIDATION TOTALaBYCASH CK MO