HomeMy WebLinkAboutBLD21212 Mobile Home - BLD Application - 11/17/1987 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 J
427-9670 DATE ISSUED
PERMIT N0.
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER l�(JA J E2 SlOo C Oe6,K9pQ#& 6r*G 4.-4 " .0)SL S/
DIRECTIONS
TO JOB SITE pl - `t,/4 r" PJ OW .5/JC l &S'OC
PARCEL EGAL
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NUMBER �j� � 3.� �QQO� DESCR.
7,,�-
CONTRACTOR
NAME MAIL ADDRESS CITY R STATE LIC&USE NO. ZIP PRbNE
�Q
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK J
BEDROOMS L DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SO. 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 OF180 DAYS AT ANY TIME AFTER WORK ISCOMMENCED.
PERMANENT '� SHORELINE ?
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CE TITIONFY THATLA I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGI RAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQ REMENTS 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 NFORMANGE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBT INING APPROVAL FROM THE BUILDING EPARTMENT, APPROVAL FROM THE BUILDING DEPARTMENT.
O NER�''� DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES
PPROVENo DEPARTMENT YES NOBUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT Z116,
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE - F
ILSTATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY ED IS C PERMIT VALIDATION
TOTAL
rB7Y . CASH CK MO
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WAY S 11989
�Q/ 'GENERAL SERVICES