HomeMy WebLinkAboutBLD89-24620 - BLD Application - 10/20/1989 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL ERVICES
P.O. BOX 186 SHELTON, WASHIN TON 98584 c
427-9670 DATE ISSUED ////r--�y�
PERMIT NO. , "�'&yo
OWNER NAME MA S CITYBSTATE ZIP PHONE
DIRECTIONS
TO JOB SITEPARCEL
NUMBER Llit, ?�-I qc" LEGAL y�
NAME MAILADDRESS CITY BSTATE LICENSE NO. ZIP PHONE
CONTRACTO Pc:) 8c,x S51 11 851 Ya-7-81-J I
USE OF
BUILDING i
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE t�
WORK ✓
DESCRIBE -}- r 1 _ Roo (� -1
WORK I eG\R- �T Cz"A Q. }�1 1�Y is i:� Rs, oC�{ S
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PEAN ITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BEC OMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTALSQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERSAFFDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY T T I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATI LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREM TS 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 CONF MANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE HEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINI APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X O ER DATE X BY �llf�1Jt,t c. DATE jo'2V
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT ve0 BUILDING VALUATION
YES NO YESS NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT co, Cab
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL <56
BY CASH CK MO