HomeMy WebLinkAbout30237 - BLD Application - 4/14/1992 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O.BOX 186 SHELTON,WASHINGTON 98584 an
427-9670 DATE ISSUED 4
PERMIT NO. 3aa3
NAME MAILADDRESS CITY STATE ZIP PHONE 4 �
OWNER ,
DIRECTIONS
TO JOB SITE 4RA A e Y2 D u 2w e ��-
PARCEL LEGAL
NUMBER Z Q DESCR. �., BeT� 4Z
NAME MAILADDRESS ITY&STATE ZIP PHONE LKENSENO.
CONTRACTOR S �4aL.YAeA, Ift OTi
USE OF
BUILDING
CLASS OF NEW '! ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE
WORK 4 1 29(✓t /e 8 4 90A. bLO4,4 tewat-
Al o
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
COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
DECKS SgFt BATHROOMS SEASONAL RES.O ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT RAG
GARAGE SgFt ATTACHED O 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.
9,0*0 C�mu,� 00te Al557- 3
X OWNER DATE 27 Q 2 !� X BY i" DATE
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FOR OFFICE USE ONLY
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 Q'(�
SPECIAL CONDITIONS BUILDING GROUP �, PRE-INSPECTION
' SHORELINE
s
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY P NS CHECK BY ED F UANCE PERMIT VALIDATION TOTAL ��
tB CASH CK MO