HomeMy WebLinkAboutBLD21796 ReRoof - BLD Application - 4/13/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
NAME PERMIT NO. S� 7% 1p
OWNER Q MAIL ADDRESS CITY 6 STATE
ZIP PHONE
TDO cx
OB SITE IRECTIONS z �
PARCEL LEGAL /�/GiE'� ° �NUMBER 02 3 3 2 S 0 DOO DESCR. T2,ac4 S_ � ° cS r E2
CONTRACTOR NAME MAILADDRESS � E M� lw��45 �+ti /�
,'/ S n �y /� �(]CI�TY&STA `, LICENSE NO.
USE OF V � y atvi 4(i S(V'/V 1� 1 0t) (i rA I4ri"�IV Ca(7 'ZIP PHONE
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BUILDING iz En,
CLASS OF
WORK ✓ NEW ADDITION ALTERATION REPAIR\ MOVE
DESCRIBE REMOVE
WORK
BEDROOMS DECKS CARPORT NOTICE
BATHROOMS TOTAL SO.FT. GARAGE CONDITIONING.
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
NO.OF STORIES � BASEMENT ATTACHED t
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
TOTAL SQ.FT. FIREPLACE DETACHED COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT_, SHORELINE
SEASONAL_ #
OWNERS AFFIDAVIT
CONTRACTORS AFFIDAVIT s
I ERTIFY 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
QUIREMENTS 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 CONFORMACE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING f
TAINING APPROVAL FROM THE BUILDING DEPARTMENT.
N
/ APPROVAL FROM THE BUILDING DEPARTMENT.
OWNEA�
DATE X BY
DATE
FOR OFFICE USE ONLY,
DEPARTMENT SPPROVE APPROVED DEPARTMENT APPROVED
YES NQ BUILDING VALUATION DO/ Q
HEALTH PUBLIC WORKS I
PLANNING FEE
FIRE BUILDING PERMIT
D.O.T. BUILDING
PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP f
PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE .2
APPLICATION ACCEPTED BY PLANS CHECK BY STATE SURCHARGE w�
APPROVED FOR ISSUANCE PERMIT VALIDATION
BY CASH CK MO TOTAL ��• �0