HomeMy WebLinkAboutBLD7660 Bldg 4 Foundation for 4-Plex - BLD Permit / Conditions - 10/5/1977 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
n� e Q�e So.t 4 QSS L2 7
DIRECTIONS
TO JOB SITE SIC All S
C - / 12 � c i r Si, dr
PARCEL LEGAL IT'0A"AINC
+ 4I;Pa 07
C>C.rv'I'1Ofi5 3d e C 0A,3l 75,23A'
NUMBER DESCR.
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
bw CONTRACTOR { ' o
USE OF AcQu
BUILDING No
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE ^�/ r
WORK ii�C co"i S 6 Gels OAj i�S e Ci C K c V :Ir 4e
5Nfz �f , to az tc�(ge N,� 4� iv 1�i
as wt it {eau
BEDROOMS - DECKS YOR N CARPO NOTICE
TOTAL SO.FT.
3 DECK yJJ, GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS
TOTAL SQ.FT.8L� TOTAL SQ.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 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
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 RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS FOR WHICH THIS PERMIT IS I9SUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. NO CHANGES HALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL F OM THE BUILDING TNENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER _DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES APPROVEDJO DEPARTMENT YES DEPARTMENT BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
IBY CASH CK MO
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED
PERMIT NO. f y r
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTI NS
TO JOB SITE
LEGAL �{ SEE ATTACHED SHEET)
DESCR
CONTRACTOR
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
/
.0 C9 7 a
USE OF ,
BUILDING
Class of work: EW ❑ AD I ON ElALTERATION ElREPAIR ElMOVE ❑ REMOVE
Describe work:
Valuation of work: $ c 4,' PLAN CHECK FEE PERMIT FEE �-
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY1 PLANS CHECK BY APP YED FOR'IS$UANCE Type of Occupancy Division
BY .�tt ;--i l Const. Group
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I certify that I am a currently registered Contractor In RESIDENCE
the State of Washington and I am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance ther h. � ZONING
�' HEALTH DEPT.
Fir PUBLIC WORKS
ROAD DEPT.
By 7
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
of the Mason County ordinance requirements for VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
j'} SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owner Date- WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. ASH
Hideaway Townhouse Trust #7660
10-5-77
Port G. L. 3 & 4 31-23-1 Bldg 4
Contractor
Foundation for 4-Plex Fab Tech
$3,180.00
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