HomeMy WebLinkAboutBLD0231 - BLD Application - 1/23/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 /
427-9670 DATE ISSUED 3
PERMIT NO. 6 2 311
OWNER LNAME MAILADDRESS CITY SSTATE �P PHONE
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DIRECTIONS ��//
TO JOB SITE S �.�T (.J —
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1 3 / u r, r Vi NC CdG �InPARCEL LEGAL CL
NUMBER ' � p 5� p� DESCR.
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NAME MAIL ADDRESS CITY&STATf LICENSE NO. ZIP PHONE
CONTRACTOR �� 1 ,�— �S-' _ , � / WQ 2-
USE OF rr 1
BUILDING C!eC- r cam. �-c5 / da.YA
CLASS OF NEW ADDITION ALTERATION REPAIR �(' MOVE REMOVE
WORK r / l/ , \
WORK DESCRIBE ro e��_ ��X Z� , GX e c� dSS' 7 30 !/ h /1
O J�G�S �� rCCNe Q K� ' 12-
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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 JAYS, 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 �c_--f —
SEASONAL
OWNERS FFIDAVIT 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
REGISTR ION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIR ENTS 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
OBTAI G APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X NER DATE X BY DATE / 3
FOR OFFICE USE O*X
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION bO�
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT S
D.O.T. BUILDING PLAN CHECK S'V
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
,�c->'� �• `'�` WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE fj Q
STATE SURCHARGE
'ION ACCEPTED BY PLA S CIjLjK BY APPROVED FOR ISSj*NCF1 PERMIT VALIDATION
TOTAL 5�
BY CASH CK MO