HomeMy WebLinkAboutBLD0007 Frame - BLD Application - 4/5/1983 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 , Shelton, Washington 98584
426-5593
DATE ISSUED
A4 #j zw PERMIT NO. L>
OWNER `Ny 'L� M`�IL�DDRESS G /�I�8 STATES - $ ^ ZIP ^PHONE
DIRECTIONS K CJ lJ G7-- , 4T— VYri�•p C�� { T S
TO JOB SITE f / s 'K/—) 'V� ,�0 / p��� �/` 1 SLA M PI) t)
LEGAL (❑ SEE ATTACHED SHEET)
DESCR.
NAME MAIL ADDRESS CITY✓£STATE LICENSE NO. PHONE
CONTRACTOR A s p7
41 PO
USE OF
BUILDING A E C Q
Class of work: ❑ NEW NADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
rl/ V
Valuation of work: $ 4z? Icni PLAN CHECK FEE PERMIT FEE
06�
h9. S
SPECIAL CONDITIONS:
"ROOM
DECKS --+ � NOTICE
��"' TOTAL SQ. FT. G M*6E—❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
S BASEME r-tfl OR AIR CONDITIONING.
�. DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the F O R OFFICE U S E ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT ❑ SHORELINES ❑
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewi h. MOTOR VEHICLE PERMIT
• Al APPLICATION ACCEPTED BY PLANS ECK BY APPROVED Fop ISSUANCE
Owner�� Date_ BYWI
P A CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH