HomeMy WebLinkAboutBLD14906 SFR - BLD Application - 11/7/1983 w
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED— +
PERMIT NO. T-1=j2:::>
CITY&STATE ZIP PHONE
N ME
MAIL ADDRESS �� 21 �()
OWNER
DIRECTIONS
TO JOB SITE
(❑ S E ATTACHED SH ET) �
LEGAL J // Ive K! /�A D H� -a 3 -
DESCR. LOT I4 9ivPx Ili �� PHONE
CITY 8 STATE LICENSE NO.
MAIL ADDRESS 77 dd
CONTRACTORaA S
USE OF „
BUILDING
Class of work: NEW ElADDITION ❑ ALTERA ION ElREPAIR MOVE ❑ REMOVE
Describe work: 6-as OQT
12a � ,5a
PLAN CHECK FEE PERMIT FEE 94c)
Valuation of work: $ C �O p1
SPECIAL CONDITIONS: J
BEDROOMS f DECKS 7GARAGE,;XK
T ❑ , NOTICE
BATHROOMS y TOTAL SO. FT. SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
ED ❑ OR AIR CONDITIONING.
NO. OF STORIES_ BASEMENT ❑ DETACHED ❑
TOTAL SO. FT. 0 FIREPLACE ❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT UON OR WORK IS
SPENDED COMMENCED
ORABA DO EIDFORTHIN A�ERIODOF180 DAYS AT DAYS,OR IF ANY TIME AFTER
WORK IS COMMENCED.
I certify that I am a currently registered contractor in FOR OFFICE USE ONLY
the State of Washington and I am aware of the
ordin ce requirements regulating the work for which
the ermit is issued and all work done will be in PERMANENT ❑ SHORELINES ❑
co formance therewith. FLOODPLAIN ❑
SEASONAL ❑
E.D. NO. S.E.P.A. El
Firm YES APPROVED NO
Special Approvals IN OUT
Date 406f') ZONING
Lic. No. PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT 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 BUILDING DEPT.
of the Mason County ordinance requirements for ROAD ACCESS
which this permit is issued and that all work done will
be in conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner
Date.
PLAN CHECK VALIDATION CK. M.O. CASH
PERMIT VALIDATION CK. M.O. CASH