HomeMy WebLinkAboutBLD14358 SFR - BLD Application - 7/12/1983 BUILD(NG PERMIT APPLICATION
MASON COUNTY '
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED 7—
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
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DIRECTIONS
TO JOB SITE �� C rA/,ot_ //'tiC 7LC; djWole1A/< A ' 1-o ,Li vP ,& H i L k- ILA-4 E PS
LEGAL (❑SEE ATTACHED SHEET)
DESCR. L�� / f(jl/L/�iL Gr y/( f?Ark
CONTRACTOR NAME MAIL ADDRESS CITY 3 STATE LICENSE NO. PHONE
Ile i b 0-0Cf PA_ (70,-r - ' 7'
USE OF
BUILDING S lNw 4,f iL.
Class of work: )l NEW ❑ ADDITICrIN ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
S D
Valuation of work: a d PLANS ECK FEE PERMIT FEE (3 0
SPECIAL CONDITIONS: p 1
BEDROOMS {DECKS CARPORT ❑ NOTICE
BATHROOMS (TOTAL SO. FT. GARAGE [��-
NO. OF STORIES BASEMENT ElATTACHED &'— SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SO. FT. jlk FIREPLACE ❑ DETACHED El
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_� �Q �i9C+�P/C &()r!/S
E.D. NO. S.E.P.A. ❑
By �6� `� Special Approvals IN OUT YES APPROVED NO
Lic. No. Date v ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS IV
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
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
WICATION ACC PTED BY PLANS CHECK BY APPR�O,V�EyD
FOR F�ORISSUANCE
Owner Date_ � Bj�%�!
P CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK M.O. CASH