HomeMy WebLinkAboutBLD2032 SFR - BLD Application - 4/21/1978 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED �� '
PERMIT NO.ME
OWNER L. l I�JI�C.L.B AG IL Al ss 441 rr a T:A -+2.WN. q zlp-,
DIRECTIONS
TO JOB SITE b t j�l Ci 0
LEGAL f (❑SEE ATTACHED SHEET)
DESCR. zt 0EIZ4411 L-L' 1
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR L Q
USE OF
BUILDING
Class of work: effNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
V'AC-46J Z L.DT c.o t /o Jet
132! 2•S� = 29 72 Z,s � -se
Valuation of work: $ PLAN CHECK FEE PERMIT FEE—X
3 8'Jr Z. -0 Zs /3 Aso
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANA CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division t_
Const Ir Group
Size of Bldg. j 3 2/ No. of Max.
(Total Sq. Ft. 6 # Stories / Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT 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
H DEPT:
Firm PUBLIC WORKS
ROAD DEPT.
By
Lic. No. 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 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 nformance 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
Qyyrr Date. WORK IS COMMENCED.
PI AN CHECK VAC IDATIC)N CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH