HomeMy WebLinkAboutBLD14359 SFR - BLD Application - 7/12/1983 BUILDING PERMIT APPLICATION all
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
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DIRECTIONS
TO JOB SITE ifJ2��/�/+L /�i4 e. 7"-0 6Wlk!A-AC A 7rO ✓L l t-le A, 11L / l_L
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. _0vCA_ � i c i--/Z,� E, rS
CONTRACTOR nNAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
1 7 P/6 e c►c e-ti
USE OF
BUILDING L
Class of work: ® NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
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Valuation o>��`$, � b PLAN CHECK�oFEE ��� �� PERMIT FEE S
o�
SPECIAL CONDITIONS: fit-!
BEDROOMS DECKS CARPORT ❑
BATHROOMS / TOTAL SQ. FT. GARAGE$ .3I$ NOTICE
NO. OF STORIES BASEMENT ❑
ATTACHED P�— SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SQ. FT.JW FIREPLACE ElDETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
/DGflCONTRACTOR 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
r Firm SEASONAL ❑ FLOODPLAIN ❑
P � �C?c'� � r? <Ii✓� T
E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. 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.
whi h this permit is issued and that all work done will ROAD ACCESS
be In conformance therewith. MOTOR VEHICLE PERMIT
Owner LIGATION AC PTED BY PLANS�BY APPROVED FOR ISSUANCE
Date. O17/ gY
PL N CHECK VALIDATION K. M.O. CASH PE MIT VALIDATION K. M.O. CASH