HomeMy WebLinkAboutBLD0388 Roof - BLD Application - 6/18/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED '
PERMIT NO.�3
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER Jack & Kathy Johnson P.O.Box 1119 Belfair, Wa. 98528 275-5400
DIRECTIONS N.E.23251 Hwy 3 Belfair, Wa. 98528 Right hand side of road going twoorhs Shelton
TO JOB SITE
PARCEL 12332 50 00022 LEGAL.
SAM B. THELER'S HOME & GAR TRS TR 10 EXC S 100' OF
NUMBER DESCR
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR Stephen Johnson Inc. N.E.701 Mission Ck.Road Belfair, Wa.98528 STEPHJ199LW
USE OFRental 275-6734
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIRRoof MOVE REMOVE
WORK ✓
WORK DESCRIBE New roof 6 0i4t , /,5 y �� p
BEDROOMS 2 DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS 1 TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES 2 BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. I100 FIREPLACE DETACHED _ ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT yes 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 BUIL ING DEPARTMENT.XOWNER DATE -- DATE ��////��GG�A—;
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVENo DEPARTMENT YESPPROVENO BUILDING VALUATION y V�
HEALTH , PUBLIC WORKS FEE
PLANNING y FIRE BUILDING PERMIT fo /
D.O.T. BUILDING 9/(-- PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION ,5 J
n j%-sc f.{/it TOTAL
91 BY4,1 6 IS—YI CASH C MO ��