HomeMy WebLinkAboutBLD89-24570 - BLD Permit / Conditions - 10/12/1989 BUILDING PERMIT APPLICATION
MASON COUNTY FS 0830�.
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED /f yG`�
PERMIT NO.C'7' t-5 /C
NAME MAILADDRESS CITY BSTATE ZIP PHONE
OWNER 4e; � 1 - p' t' .- 3 C17 ni hgiten WA
DIRECTIONS -.-
TO JOB SITE �,�! d� .;.� t nC �c� c In cl L.k Pa . (L,v r, t-ic ht s, s W 1-K R,
<`S /,-"Vv V Nt- iunIc OteIZ0 L;.9u �+zn t,,,, Le-q
PARC L LEGAL
NUMBER _ 0c_ DESCR. C h Y % V- k< Lo4 .3
NAME MAILADDRESS CITY TATE LICENSE NO. ZIP PHONE
CONTRACTOR e PC) e 51 »� 1�.1 c- 5 -7-�� 1 R
USE OF p BUILDING l i'l LSt44 I es I d erice.
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE �-
WORK ✓
DESCRIBE _
WORK T �`►' c'.
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORI ES 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 ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT 1 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 ALL 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 THE BUILDING DEPARTMENT.
XOWNER DATE X BY JJL )-y)d�.Ll-a- DATE �6'_s �S
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
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 '
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
BY CASH CK MO