HomeMy WebLinkAboutBLD0442 - BLD Application - 9/23/1986"An
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED l/,�3 L
NAME PERMIT NO._�7 7
OWNER ealf1�e MAILADDRESS CITY&STATE
ZIP PHONE
6 'l wo e /e .� 3 l
DIRECTIONS
TO JOB SITE
LEGAL
DESCR. �' �', IfIlJ� Tr, zoje'���97
CONTRACTOR NAME 'MAILADDRESS FITT&STATE LICENSE NO. ZIP PHONE
USE N
BUILDING /•
CLASSOF NEW
WORK ✓ ADDITION ALTERATION REPAIRv- MOVE REMOVE
DESCRIBE
WORK -4_
4117
BEDROOMS DECKS CARPORT NOTICE
BATHROOMS TOTALSQ.FT. GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
CONDITIONING.
NO.OF STORIES BASEM ENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
TOTAL SO.FT. FIREPLACE COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS FFIDAVIT 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
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 CON ORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAIN G APPROVAL FROM THE BUILDING DEPARTMENT. j�lj�
APPROVAL FROM THE BUILDING DEPARTMENT.
X NER DATE X BY � /
DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED APPROVED DEPARTMENT
res No YES No BUILDING VALUATION �� d
HEALTH PUBLIC WORKS
FEE
PLANNING FIRE D.O.T. BUILDING PERMIT
a a
BUILDING PLAN CHECK
SPECIAL CONDITIONS N
BUILDING GROUP PRE-INSPECTION
SHORELINE _ -vQ
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHE BY APPROVED FOR ISWANCE PERMIT VALIDATION
IF 9 BY l CASH CK MO TOTAL