HomeMy WebLinkAboutBLD90-25416 COVER - BLD Application - 3/14/1990 BUILDING PERMIT APP (CATION
MASON COUNTY
DEPARTMENT of GENERALS RVICES
P.O. BOX 186 SHELTON, WASHING ON 98584
427.9670 DATE ISSUED �,_
j- PERMITNO.4-��/4
NAME C' MAILADDRESS CITY&STATE ZIP PHONE
OWNER .✓ 'T-v fJ �; C-�E�cr :�
DIRECTIONS .--�
TO JOB SITE
PARCEL
LEGAL _
NUMBER �a Uv y-yv zN),I
NAME MAILADDRESS CITY BSTATE LICENSE NO. ZIP PHONE
CONTRACTOR lea a� �►^oiu E..219� �'� ew r- `/"�'3 YE ti4,; o o
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE ,
WORK Ell
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.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
OWNERSAFFFzIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY TH I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I 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 A D I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREME S 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
IN CONFO ANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE HEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING PPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FRO THE BUILDING DEPARTMENT. r�
X O. R DATE X BY cl DATE
FOR OFFICE USE ONLY
APPROVED APPROVED BUILDING VALUATION
DEPARTMENT YES No DEPARTMENT YES No
HEALTH; PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
"STi:.1�a WOODSTOVE
J PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY I PLANS CHECK BY AID D R ISSUANCE PERMIT VALIDATION � i
i, TOTAL l/a U
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