HomeMy WebLinkAboutBLD26267 Mobile Home - BLD Permit / Conditions - 7/25/1990 Shorelines:
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., BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED 1 �5
PERMIT NO.
OWNER ME MAILAD`D�RESS Q CITY&STATII ZIP PHONE
b 0 N `7 /C 0C CK Py yjo y
DIRECTIONS I '/ /,
TO JOB SITE �C �. F ,L{- 10 DN W S, d e F /� y ? �UCX o 1.kc C ov /-A.vPARCEL LEGAL11 '
>r
NUMBER 2 3 0-77'0004 DESCR. SAC 30 Tto I° 2 zAl U) ; U91 Aged F
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR �e r
USE OF '
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE, REMOVE
WORK ✓
DESCRIBE f //
WORK 0 , 1- �d c
BEDROOMS - DECKS AR N CARPORT Q. NOTICE
TOTAL S FT.
DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS— TOTAL SQ.FT. D TOTAL SO.FT. CONDITIONING.
NO.OF STORIES BASEMENT Y OF& THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA BASEMENT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. TOTAL SQ.FT: CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT FIREPLACE ATTACHED
SEASONAL SHORELINE DETACHED
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
1 CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS 1 CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
GISTRATION LAW FICA!18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
OUIREMENTS 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
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.
X OWN ER %A'
ATE 3 - V XBY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING h PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
' SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE 7
APPLICATION ACCEPTEDBY PLANS CHECK BY AP VED FO UANCE PERMIT VALIDATION '
p TOTAL
�-ZS-9 0 BY CASH CK MO
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