HomeMy WebLinkAboutBLD0617 2 Doors, Windows, Flooring, Restorooms and Wallboard - BLD Application - 3/15/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 S��
427-9670 DATE ISSUE
PERMIT NO. C>G 7
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER �° 1Nvo)),FoRb ✓�� ,3 .S� _ cZ� �a�l
DIRECTIONS z ^ �
TO JOB SITE
PARCEL
LEGAL
N U M B E R,0_: 1,5 DESCR. �QQ cZ�, 3�5
NAM, MAILADDRESS CITY&STAT LICENSE NO. ZIP PHON
CONTRACTOR �Yi �' �� �L-' /l�CCO�= !�D ,�j t1}c'l � GY��S'%ate l�
USE OF (�
BUILDING 1✓Pg0F/7F . &'1` /L 5.��,t�`�� �T�.�Go/✓r ��'�Py� �r�l�s V ���C
CLASS OF WORK ✓ NEW ADDITION ALTERATION pi
REPAIR MOVE TREMOVE
DESCRIBE
WORK o� 2o i -x� Zfic�
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.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
TOTALSQ.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 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
REQUI EMENTS 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 CgNFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAI ING APPROV L FROM THE BUILDING EPARTM NT. APPROVAL FROM THE BUILDING DEPARTMENT.
O` NER ATE XBY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES NO
NO DEPARTMENT YES No
BUILDING VALUATION
! SQo,o
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT �5 O
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL ��o
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACQI5PjrED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
BY 4:?_ C/01 CASH CK MO TOTAL �� Q�