HomeMy WebLinkAboutBLD0109 - BLD Application - 5/9/1989 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
N ME MAILADDRESS CITY&STATE ZIP
OWNER e✓s -- Z S
DIRECTIONS /
TO JOB SITE '� cc / O D o.
o ' 0/ C O �G�f
PARCEL LEGAL �/�/ �y
NUMBER ZYNAME
Q b j(p DESCR. ,40 D , tit C// C_ d
MAI DDRESS CITY&STATEZIPCONTRACTOR �.
USE OF Z
BUILDING �"e �v✓� W ol� --5/r or t e rtos U "' f�f7•
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE /
WORK �. .� t a./ tre ce� to f�� f? If"t w d e C a.� G r
r- v
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 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. — , FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE '1 _ ^
SEASONAL e Ie 6 `S (-7 C A'Z 28D
OWNE a AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERT THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGIS ATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQU EMENTS 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 NFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBT NING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
ANER DATE X BY DATE 0/0
FOR OFFICE USE ON
APPROVED DEPARTMENT APPROVED BUILDING VALUATION
DEPARTMENT YES No YES No
HEALTH PUBLIC WORKS FEE
PLANNING FIRE °O BUILDING PERMIT
�'�/
D.O.T. BUILDING !�� PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP 4&.414- PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE J�Q
STATE SURCHARGE
`t APPLICATION ACCEPTED BY P/L,AN/S CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION TOTAL Q4
BY "e tE CASH CK MO