HomeMy WebLinkAboutPre-Inspection to Determine Structure Integrity of Cabin - BLD Application - 7/9/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584 r
427-9670 DATE ISSUED
,vPJ, 1 17,q - U .3 551 PERMIT NO.
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWN E ;v -RPC /7 / A-50 J G DR E ` 5 4-
DIRECTIONS
TO JOB SITE
PARCEL LEGAL /.()T .7 I OF ^9 / tF'S -5thtI&I ,07 E /9/-)OW ltlO (`' PA
NUMBER DESCR. GI�UC nJ ;"�C G L
NAME MAILADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR
USE OF
BUILDING 1A�}'�
WORK F NEW ADDITION ALTERATION REPAIR MOVE REMOVE
CLASSWORK
DESCRIBE
r
WORK I,' �
1 J
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR P NG, HEAT � ENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.❑ THIS PERMIT BECOMES NULL AND VOID OR CON TRy
ON AUTHORIZED IS NOT
DECKS S Ft BATHROOMS SEASONAL RES.❑ COMMENCED WITHIN 180 SAYS, OR CO TRUCTI N RK IS SUSPENDED OR
g ABANDONED FOR A PERIOD OF 180 DA T A Y TIME FTERK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED❑DETACHED❑
OWNERS AFFIDAVIT CONTRACTORS AFFIDAM
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A R LY RE ED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM A OF THE R N E REQUIREMENTS REGULATING THE
REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE IS 1 ED NO ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH. O CHANGE S AL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDIN EPARTME T.
OWNER DATE �� X BY __ DATE
FOR OFFICE USE ONLY
DEPARTMENT YES No
O DEPARTMENT YES APPROVEDBUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL DITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
O'ESr r' '.'Al C� -( — �.� n� J :fJ ; ' . PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE I PERMIT VALIDATION
TOTAL
BY CASH CK MO