HomeMy WebLinkAboutBLD17522 SFR - BLD Application - 6/12/1985 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED 6 12?—e�-f%6r —
PERMIT NO. /
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
240 rn P 04 ' A c( s— p Q
DIRECTIONS ` r kLl
V�
TO JOB SITE /
JXGAL y� A (❑ SEE ATTACHED SHEET)
DESCR.
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
o/P N S'c-r,i -✓cam ry Sr/] 2. 6 7 Cam. 2_6 _-L-4r 2
USE OF ' J f 0
BUILDING �� Qr
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: ,
_C� 7
Valuation of work: $ O PLAN CHECK FEE PERMIT FEE —
gFe. aS �a
SPECIAL CONDITIONS:
I
BEDROOMS If DECKS CARPORT ❑ , NOTICE
BATHROOMS TOTAL SO. FT. GARAGE 1--210
j ATTACHED SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ (� OR AIR CONDITIONING.
TOTAL SO. FT. 0o 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 FORA PERIOD OF 180 DAYS AT ANYTIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I am aware of the FO F F I C E USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
nformance therewith. PERMANENT SHORELINES ❑
11 SEASONAL ❑ FLOODPLAIN ❑
Firm` —A E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
1 �I2N e�i . �•�� ZONING
Lic. No. Date
±LEALTH DEPT. f 1 ✓
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
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK B�Y� APPROVED FOR ISSUANCE
Owner Date.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH