HomeMy WebLinkAboutCOM23965 Add New Office - COM Application - 6/28/1989 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NOcQ.--? �
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER E9CwA7.'oNAt F Rrsr"s /we, Rc,r3a-,,( 84 Lv,4 U581/ 124-06'77
DIRECTIONS TO JOB SITE Par of 5#eLraN-- 5Ampi Jxs'oN FFLD /JupvrTRIAL P-4R.K- rna%-L4 w S)ZAIS
`To 7"-#iS Jt3U1i-pl*C l S w,5sT oc rw REcyl-JWC 13Lp6 460
PARCEL ��// �/ �y LEGAL -� t/ �,/1007/1- T/; /
NUMBER 7a 7 /� O�/e DESCR. 'LOry / �
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP HONE
CONTRACTORZ 5>�N,t 3`JJM
USE OF
BUILDING AAvj?'rOJVA L OFF 1 c r YP,#cE
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK A v D NLrw 0 FP)cF_ 5PAC6 IN NORTH E0D aF BliiI.DJJVG-FkAM5 CONS'Tevz-
li-6,y ON F-v r77NG coNtlr grC rj-conivir# swELT eccecoiLwas# k/.IlLS��t.E�rR�c
k)gA-r,
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. Zti GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED 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
TOTAL SQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASOtJAL
OWN RSAFFIDAVIT C CTORSAFFIDAVIT
I CE IFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I A RRENTLY RE RED CONTRACTOR IN THE STATE OF
REGI RATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWA T RDINANCE REQUIREMENTS REGULATING THE
REQ EMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PER IS AND ALL WORK DONE WILL BE IN
IN NFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWI O CHANGES SHA ADE WITHOUT FIRST OBTAINING
OBT NING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM T LDING DEPARTMENT.
X NER DATE DATE
FOR OFFICE USE ONLY
- APPROVED APPROVED C
ID ARTMENT YES No DEPARTMENT YES No BUILDING VALUATION 7 SO o
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
c�S:cb
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
I
WOODSTOVE
PLUMBING
MECHANICAL
I
STATE BUILDING FEE Q
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CH K BY APPROVED FOR I SUANCE PERMIT VALIDATION
�Qf TOTAL
BY L CASH CK MO
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