HomeMy WebLinkAboutBLD0166 Change of Use - BLD Application - 8/29/1989 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED 44
PERMIT NO./1 l
OWNER NAME MAILADDRESS CITY&STATE ZIP f/ PHONE
eW ooV 42 7-71d4 lv r (' re/e A,
DIRECTIONS
TO JOB SITE 7-rQL h
PARCEL LEGAL i ��,
NUMBER 233.?s� O&V 63 IDESCR. AM 7"ljrLt'.j llp oe f C.�c�t.[I � • a
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK s 4U /
:!?)"r—e4DM e-5-0"4C -11-D Ism
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.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 ANYTIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OW RS AFFIDAVIT CONTRACTORS AFFIDAVIT
I C TIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
R ISTRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
UIREMENTS 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
I 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 OWNER DATE 6 12 -�ff X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION �}
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT 2 5 D
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP B PRE-INSPECTION
SHORELINE
WOODSTOVE
LUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE '
APPLICATION ACC ED BY PLANS CHE BY APPROVED FOR ISS NCE PERMIT VALIDATION
TOTAL '
IBY CASH CK MO
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