HomeMy WebLinkAboutBLD25774 Mobile Home Move - BLD Application - 5/25/1990 BUILDING PERMIT APPLICATION
M��``'' , N COUNTY
DEPARTME10 GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
57
PERMIT NO. s.1
OWNER, NAME MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE Ato, t !nl Oacm;;A S'rA= D/ Le
PARCEL LEGAL j71i9CT O 6'OV F 7 1 Z 5 45
NUMBER Q 3 DESCR. F Qa
CONTRACTOR NAME 000490 MAILADDRES � CITY&STATE LICENSE NO. ZIP PHONE
USE OF
BUILDING
CLASS OF NEW ADDITION [ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE 1. . �. ;, .
WORK gy ! ! ex, ljy
CARPORT,
BEDROOMS DECKS P OR N TOTAL NOTICE
BATHROOMS DECK GE'
SEPARATE PERMITS ARE REOUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
TOTAL SQ,FT. TOTAL 3Q,FT. CONDITIONING.
NO.OF STORIES BASEMENT Y OR N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA BASEMENT: COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED.OR
TOTAL SQ.FT. TOTAL$Q.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT FIREPLACE ATTACHED
SEASONAL SHORELINE DETACHED
OWNERSA IDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY TH T I AM EXEMPT FROM THE REOUIREMENTS OF THE CONTRACTORS 1 CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATIO LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGW ATI"THE
REOUIREMEN 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 AE IN
IN CONFO NCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST'OBTAINING
OBTAINING VAL FROM THE BUILDING DEPARTMENT. �-- APPROVAL FROM THE BUILDING DEPARTMENT.
X OWN DATE y �l X BY DATE
FOR OFFICE USE ONLY
DEPA ENT APPROVED DEPARTMENT APPRov BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FIDE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP �ji�� PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY F UANCE PWMITVALIDATIO
7, �;-Z�3"30 [WBY CA Mo TOTAL