HomeMy WebLinkAboutBLD N/A Bulkhead - BLD Application - 6/3/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O.BOX 186 SHELTON,WASHINGTON 96584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAME MAILADDRESS CITY BSTATE ZIP PHONE
DIRECTIONS
B 8 T TO J E Q 0 '9 -
PARCEL LEGALl� 'l / s I� O/c
NUMBER DESCR. 541, G
CONTRACTOR NAME MAIL ADDRESS CITY&STATE a mcm LICB18ENa
1 s E D
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r ��
DESCRIBE
WORK 4CO C ;r LO I/
" S 7
Zook-xgwis w goc / P —/9 D
AREA- NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RE81DEWE SgFt STORIES SHORELINE CONDITIONING.
BASBIAENT SQFt BEDROOMS PRIMARY RES•O 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
DIM.' NFt BATHROOMS SEASONAL RES.O ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARFIORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAtiE SgFt ATTACHED O DETACHED O
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 ROW 16.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
AB MENTS FOR WHICH THIS PERMIT 18 ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN OONFORMANCE 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 OWNE ATE 161cl X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT Y�PPROVE NO DEPARTMENT YESOVENo I BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APP{.ICATION ACCEPTED BY [PLANSCHECKBY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
BY CASH CK MO