HomeMy WebLinkAboutBLD0434 Glass Windows - BLD Application - 9/9/1986 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED 9J "
PERMIT NO. j::jy•3
NAME ( MAILADDRES CITY&STATE ZIP PHONE
OWNER cnc� a �,n a Con e�S eL — t07
DIRECTIONS
TO JOB SITE
�C ,do.%� �tti�c/- �acC J -�aYw�.G✓ Y / / �.� k.
LEGAL to/ C '7- ( I, , ��a ,r W_
DESCR. (�. / 7 Dl Sac Z 8 l 2�� I O c� S1Jo�l
CONTRACTOR �(aME MAILADDRESS_ CITY&STATE LICENSE NO. ZIP PHONE
1� LC5ram2 29D
USE OF
BUILDING �GV �•/ S� s � -a7s�li �p �'y
CLASS OF NEW ADDITION ALTERATION REPAIR MID MOVE
WORK --
DESCRIBE
WORK e-- a S
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 CERTFY 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.
XDWNER Lg�� DATE X BY DATE
FOR OFFICE USE N
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION �
YES NO YES NO C�QC,
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT 38, 5
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE _j C
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CH KBE APPROVEDF RRRIISSUA CE PERMIT VALIDATION
�>c '7 BY �f,� CASH CK MO TOTAL '�� GC%