HomeMy WebLinkAboutBLD91 - BLD Application - 5/21/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES 2-
426 W.CEDAR/P.O. BOX 186 SHELTON,WA HINGTON 98584
427-9670 DATE ISSUED ' _ fA
PERMIT NO.
NAME MAIL ADDRESS C TY&STATE ZIP P NE
OWNER
DIRECTIONS c t
TO JOB SITE Cti l R 1 C j l �� C,
PARCEL LEGAL
NUMBER �'Z,C'ti"1 -l L -C'j �} DESCR.
NAME MAILADDRESS CITY&STATE ZIP PHON E LICENSE NO.
CONTRACTOR L
USE OF '�r
BUILDING ' �" € ry L. ,
CLASS OF WORK NEW ADDITION ALTERATION REP IR MOVE REMOVE
DESCR
✓ (�, ,
WORK IBE "�- �. ��
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR C014STRUCTION AUTHORIZED IS NOT
DECKS S Ft BATHROOMS SEASONAL RES.❑ COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
g ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AF TER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED❑DETACHED❑
OWNERSAFFIDAVIT 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 ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND kLL WORK DONE WILL BE IN
IN CONFORMANCE 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 E BUILDING DEPARTMENT.
X OWNER LpATE �� �1 -01 I X BY _ DA E
FOR OFFICE USE ONLY
DEPARTMENT Y APPROVEDJO DEPARTMENT YEAPPRO ENO BUILDING VALUATION
HEALTH PUBLIC WORKS FE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
�, SHORELINE
This permit is for the storage of the mobile only. WOODSTOVE
It is NOT to be occupied at any time. Mobile Home is not PLUMBING
To be hooked up to septic, water Or power at any time. 1 MECHANICAL
This 1�ermit is validuntil 6-20-91. - STATE BUILDING FEE:
APPLICATION ACCEPTED BY I PLAIV CHECK BY APP ED ISSUAN PERMIT VALIDATIOIN
TOTAL ,
B CK MO