HomeMy WebLinkAboutSFR5715 SFR - BLD Application - 4/23/1977 Y BUILDING PERMIT APPLICATION
a ,
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED -f?0 -7
PERMIT NO. ? 71
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS '
TO JOB SITE ! t9�1 � ���I +" ly�'� "� �� k. 1 f �` �7� I IF a
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. _ 1 r ')
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR &I
USE OF e,-j
BUILDING "
Class of work: UVNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
•� �`.
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
(CATION ACCEPTED BY1 PLANS CHECK BY A IIED FOR ISSUANCE Type of Occupancy Division
) B ( ✓(1 f t t -+ Const. Group
(G e liltL C@- L
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT —
PERMANEN SEA T SONAL 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
_ /+ HEALTH DEPT.
Firm F �� i-. C 0 1 s PUBLIC WORKS
By ROAD DEPT.
Lic. No.- �� 1 Date
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
of the Mason Count ordinance requirements for SEPARATE PERMITS ARE REQUIRED NG. FOR ELECTRICAL, PLUMBING, HEATING,
Y q 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 Date. WORK IS COMMENCED.
P N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK,; M.O. CASH