HomeMy WebLinkAboutBLD23653 Building - BLD Application - 5/4/1989 i
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
1�0 �00 1 426-5593 DATE ISSUED
PERMITNO.<=a36
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
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DIRECTIONSj�Co 3U
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LEGAL
DESCR. TRt�t(T ( £ '�F 5)(GRT- e,-A-7')-7 1 Xi.-I 1 i c25 f:'.
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK
BEDROOMS 0 DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES 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.CA) FIREPLACE DETACHED ABANDONED FOR A PERIOD OF180 DAYS AT ANYTIME AFTERWORKISCOMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY HAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
CERTIFY
ON LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIRE NTS 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 CON RMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINI G APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X O ER DATE C' X BY DATE
t FOR OFFICE USE ONLY
DEPARTMENT YESPPROVENo DEPARTMENT YESPPROVENO BUILDING VALUATION
HEALTH 41/J PUBLIC WORKS FEE
PLANNING xl,4 FIRE BUILDING PERMIT /3qo 5 D
D.O.T. BUILDING l PLAN CHECK
�5.
SPECIAL CONDITIONS BUILDING GROUP _ PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICAT ACCF�PTED BY I PLANS CHE BY APPROVED FOR IS UANCE PERMIT VALIDATION
TOTAL
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