HomeMy WebLinkAboutBLD27254 Addition of Basement - BLD Application - 1/23/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WA, r:
SH�IN)GTON 998584 -
427-967�;(9-� �[1-/.">
DATE ISSUED
f m J PERMIT NO.
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OWNER NAME ADQRE S CITYBSTATE ZIP PHONE AI
DIRECTIONS
TO JOB SITE
PARCEL LEGAL
NUMBER DESCR. �,� o �� tau
CONTRACTOR
NAM MAIL ADDRESS Y 8 STATE LICENSE NO. ZIP PHONE
,
USE OF
BUILDING
WORK ✓CLASS OF EW ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE
WORK
r
BEDROOMS 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 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF180 DAYS AT ANY TIME AFTER WORK ISCOMMENCED.
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
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.
X OWNER TE _ X BY _ _--_ DATE _
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION tI G' %
YES NO YES NO 7 Ve,
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT s�v
D.O.T. BUILDING PLAN CHECK S p
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE J
STATE SURCHARGE
APPLICATION ACCEPTED BY PLAN /CIS `KK BY APPROVE FOR ISSU E PERMIT VALIDATION
LC TOTAL
BY �, CASH CK MO