HomeMy WebLinkAboutBLD28904 MOBILE HOME - BLD Application - 8/26/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
t'1 427-9670 �, 9� DATE ISSUED
PERMIT NO. 099
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
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TO JOB SITE l c>.te- Pb,Y-
12 12 'C Q — —
PARCEL LEGAL
NUMBER y-i-k IS DESCR.
NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR
USE OF
BUILDING C
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE (c REMOVE
WORK ✓ —
DESCRIBE �1 ,p�
WORK pu-7 \V\ n_-a � v I{C LrTra.Ylr( wT h
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE STORIES SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS 2- PRIMARY RES.Ci- THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
DECKS SgFt BATHROOMS SEASONAL RES. ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED U DETACHED U
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 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.
X OWNER DATE X BY DATE
FOR OFFICE USE ONLY
APPROVED PR DEPARTMENT YES NO DEPARTMENT YES NO BUILDING VALUATION D
HEALTH PUBLIC WORKS FEE
PLANNING 1 FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
I 3 y SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY PLANS CHECK BY/J� APPR ED R ISS CE PERMIT VALIDATION T
-a�� BY CASH CK MO TOTAL