HomeMy WebLinkAboutBLD14843 SFR - BLD Application - 10/20/1983 BUILDING PERMIT APPLIeATION
M SON COUNTY
P.O_. Bo 81x 6 Shelton, Washington 98584
426-5593 DATE ISSUED 10 -I3)D g 3
PERMIT NO. '
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER R,o>D CLOG p/t (?Orvf Y- �U /Y/7Saq Guav X^-.W—rbw. qj' /p 377-o�u4
DIRECTIONS
TO JOB SITE 64 gPL q/4 ia�f /M/u Al d-y' A'4-0k AAC AV LPG? 4144-)4 R► 4f 4/K.4,f ill 4—
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. LO-r 4,61-t-
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
,I)ynt� J� v wiv a it
USE OF
BUILDING ®Z,0SP.
Class of work: RINEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
r-C)
Valuation of work: $!J?� �DO PLAN CHECK FEE PERMIT FEE �O
..�
SPECIAL CONDITIONS:
BEDROOMS 3 DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE
ATTACHED i3� SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES_ BASEMENT OR AIR CONDITIONING.
TOTAL SQ. FT.i d 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 ❑
SEASONAL ❑ FLOODPLAIN ❑
Firm �P)p eDO�P1 �C!!►'1"T
I E.D. NO. S.E.P.A. El
By 9V� /+u� Special Approvals IN OUT YES APPROVED NO
Lic. No. Date JO ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certif that I am exempt from the requirements of the FIRE MARSHAL
con ct or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
hich this permit is issued and that all work done will ROAD ACCESS
e in conformance therewith. MOTOR VEHICLE PERMIT
' AP �BY PLANS CHECK BY APPROVED FOR ISSUANCE
er Date. �D�� �' BY,/Q��
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH