HomeMy WebLinkAboutBLD0113 SFR - BLD Application - 1/31/1984 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED!
PERMIT NO. 6 /
OWNER yyA E MAIL ADDRESS CITY 8 STATE ZIP PHONE
40 J��sPj ` 'o
DIRECTIONS
TO JOB SITE lie- f
gt'n A�4n
LEGAL , (❑ SEE ATTACHED SHEET)
CONTRACTOR
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF V /"
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
e'cd
1 o a
Valuation of work: �,/ Q PLAN H C FEE PER FEE S—a
SPECIAL CONDITIONS::
BEDROOMS {DECKS ,CARPORT ❑
NOTICE
BATHROOMS TOTAL SO. FT. GARAGE
S'7
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED AIR CONDITIONING.
TOTAL SO. FT.ILO FIREPLACE ❑ DETACHED ❑
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 USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES AIA
❑
/ SEASONAL ❑ FLOODPLAIN ❑
Firm e/tJ S ei�./
E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. o.z/e/J s�l� y�� D G Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT
HEALTH DEPT. /
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 BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
APE (CATION ACCEPTED BY PLANS HECK BY APPROVED FOR ISSUANCE
Owner Date. • � � e���
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH