HomeMy WebLinkAboutPre-Inspection No. 25288 - BLD Application - 3/12/1990 BUILDING PERMIT APPLICATION
` MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO. t/4;i
NAME MAILADDR SS CITY&STATE ZIP PHONE
OWNER �wefOct, N A i 5 I 2&th b)
DIRECTIONS z uTtit OF-rwA" ST'• fIPV,'"C4AMOffS Si64 11 T16EXTS 00•i1) U HILL To --ry�
TO JOB SITE
u l.. T �T � vr � aPt�2�x r- • � (mo44%T%f- 6?Ar� Pcs
w C4�41 N-- & t� Z4CA 4005 -t 5
PARCEL LEGAL n
NUMBER Jg35-75--a) 1v DESCR. 7-R D' SulL1l/L MIDI, /' a10-.1-73
NAME MAILADDRESS CIT &STATE LICENSE NO. ZIP PHONE
CONTRACTOR OHMS $&S - 1 I4 7
USE OF L_ ^����� ��6L .
BUILDING a�1p� i�
CLASS OF NEW �( ADDITION ALTERATION REPAIR MOVE--1 REMOVE
WORK r /\
DESCRIBE
WORK
BEDROOMS `�- DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS Z 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
TOTALSQ.FT. FIREPLACE4W DETACHED X ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT tkg SHORELINE _
SEASONAL
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 ICH HIS 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 THEREW TH. NO NGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPR AL FROM HE B LDING D ARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
jp r
X NE ATE 3 X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES
PPROVENo DEPARTMENT YES NO
BUILDING VALUATION
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 APR ED ISSUANCE PERMIT VALIDATION TOTAL
-)- 2 -`�rV BY CASH CK MO