HomeMy WebLinkAboutBLD13649 SFR - BLD Application - 2/28/1983 w _ BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 pr g3
DATE ISSUED O
, ro i :. PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
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DIRECTIONS 1>Q"JC%r,••y 'S*AfteD W, 6TI1,4 PL- SwTMI 4b-R
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LEGAL c� L (❑ SEE ATTACHED SHE
DESCR. 1� '1 OR �V [ � ZR dr. MIW �7C 93I
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR AF30-ulE
USE OF
BUILDING
Class of work: JCNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
d �
Valuation of work: $ PLAN CHQCK FEE PERMIT FEIV y„ r(DY
SPECIAL CONDITIONS:
BEDROOMS DECKS ARPORT ❑ NOTICE
BATHROOMS` TOTAL SO. FT. qOQ+•rTTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE V 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 FOR OFFICE U S ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT ❑ SHORELINES
SEASONAL ;74 FLOODPLAIN ❑
Irm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
ZONING
Lic. No. Date
AN-NI a ,,� '-Z,'%
OWNERS AFFIDAVIT EALTH D /5, r
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 ILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
btCH
i conformance therewith. M TOR VEHICLE PERMIT
ICATIO�C ED Y PLANS CHECK BY APPROVED FOR ISSUANCE
^' ` Date. BY
VALIDATION CK. M.O. CASH RMIT VALIDATION CK. M.O. CASH