HomeMy WebLinkAboutBLD8858 Barn - BLD Application - 2/11/1976 St, e,1' d e
B UI L®I NG PERMIT APPLI CA ION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584
qZ6 /a �3 6�0`6,?0 DATE ISSUED
PERMIT NO.—
---- -- ����� MAIL ADtlR SS - --_ZIP -_--_ PHONE -- --
OWNER
DIRECTIONS�
TO 10B SITE
-LEGAL J �L 21P (aBCC ATTACNCD SHCCT)
MAIL ADDP ESS PHONE
CONTRACTOR ,
— -- -- -- — -------- — —
USE OF— — �J'? MAIL ADDRESS PNONC LICENSE NO.
BUILDING
Class of vrork: NEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑MOVE ❑ REMOVE
Describe work:
Valuation of work:$ /j ` PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS: y�
XIL
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY
Type of Occupancy
Const. — Group Division
Size of Bldg. No.of Max.
(Total)Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT 8 ectel Approvels Required Received Not Required
I Certify that I am a currently registered contractor in the State G
of Washington and the County of Mason and I am aware cf the HEALYH DEPT,
ordinance requirements regulating the wclk fcr which the permit RKB
Is Issued and all work done wi,l be in conformance therewith. AZ5At5 DIM
Firm _ --
By
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the contract.
or registration law RCW 18.27, and am aware of the Mason N 0 T I C E
County ordinance requirements for which this permit is issued
and that all work done wil! be in conformance therewith. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING,
HEATING. VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTIAORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC-
.� // TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF
Date 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
Owner
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION (CK. M.O. CASH
Z,
SHELTON PRINTING CO.