HomeMy WebLinkAboutBLD9527 SFR - BLD Application - 3/8/1978 r
MASON COUNTY
P.O. Box 186 Shelton, Washington 9M4
DATE ISSUED
PERMIT NO. 9s`a 7
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL (❑SEE ATTACHED SHEET)
DESCR. f?S�" O of 7,7z ' 'f 7/9 0 - aWf�V� v/`�oT O� Sic w ZZ
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING S
Class of work: 9?14EW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
5���y C�9i�.yvo Moo�G
Valuation of work: $ Z po PLAN CHECK FEE PERMIT FEE
41
�o
SPECIAL CONDITIONS:
APPLICATION ACCEPTED B PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
Const. Group
Size of Bldg. No. of Max.
(Total)Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMAN NT SEASONAL E.D.NUMBER
I certify that I am a currently registered contractor in RESIDENCE
the State of Washington and I am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
�/✓/ /�l.FiyS HEALTH DEPT.
Firm s-- /7• PUBLIC WORKS
ROAD DEPT.
By
Lic. No. .eelw /3Fw 323 le--' Date 37 7
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
of the Mason County ordinance requirements for VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be In Conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120_DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owner 4 Date, WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION C M.O.' CASH