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HomeMy WebLinkAboutBLD4753 SFR - BLD Application - 5/10/1977 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 DATE ISSUED_ ,S / �� 7 PERMIT NO. OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE DIRECTIONS TO JOB SITE LEGAL DESCR. ��r (❑ SEE ATTACHED SHEET) �v 7 CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE USE OF SJi< �1G�zz /a© BUILDING Class of work: EW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: / V 'Ll Valuation of work: $ � / «; PLAN CHECK FEE PERMIT FEE SPECIAL CONDITIONS: APPLICATION ACCEPTED BY PLANS CHECK BY APPR anc P Y ED FOR ISFANCE Type of Occupancy BY C� j—C-<-'�-1" Const. Division Group T Size of Bldg. No. of Max. (Total) Sq. Ft. Stories Occ. Load CONTRACTOR AFFIDAVIT I certify that I am a currently registered contractor in RESIDENCE PERMANENT SEASONAL E.D-NUMBER the State of Washington and I am aware of the ordinance requirements regulating the work for which MOBILE HOME the permit is issued and all work done will be in Special Approvals Required Received Not Required conformance therewith. ZONING _ HEALTH DEPT. y Firm_ 57 P //E h ( ' if /r PUBLIC WORKS By ROAD DEPT. Lic. No. �, .��%�'' - � ? i 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 County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, which this permit is issued and that all work done will VENTILATING OR AIR CONDITIONING. 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 Owner Date SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER _ WORK IS COMMENCED. P AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH