HomeMy WebLinkAboutBLD0389 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 MAILADDRESS CITY&STATE ZIP PHONE
OWNER Jack & KathyJohnson P.O. Box 1119 Belfair, Wa. 98528 275-5400
DIRECTIONS H.E,23221 H 3 Belfair, Wa. 98528 Right hand side of road going south twords Shelt n
TO JOB SITE �`'y � g g g
PARCEL LEGAL Sam B. Theler's Home & Garden Trs S 100' OF TR 10
NUMBER 12332 50 00023 DESCR.
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR Stephen Johnson Inc. N.E.701 Mission Ck Rd. Belfair275-6734
USE OF
BUILDING Rental
CLASS OF NEW ADDITION ALTERATION REPAIR RRRf MOVE REMOVE
WORK ✓ XX
DESCRIBE New Roof
WORK �tJOK /7 4 0217
BEDROOMS 3 DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS 1 TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES 1 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. 1_000 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 BUILDIN DEPARTMENT.
X OWNER DATE — X — DATE �� �
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION V
HEALTH 71V/ PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT S O
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDINGGROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE S
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
BY G %�`�� CASH C MO TOTAL