HomeMy WebLinkAboutBLD0321 SFR - BLD Application - 7/30/1985 a
+ BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 -7 AS DATEISSUED
PERMIT NO.
/� NAME AIL ADDRESS ZIP PHONE
R ,600L ® Q I CITY 6 STATE
DIRECTIONS
6 S la a.�e lea b�,3 91 -Yf e
TO JOB SITE
New rk Pq, •� al�on,a % on l4/ver `t
LEGAL
DESCR. C;NdE
, ��I (❑ SEE ATTACHED SHEET)
CONTRAC MAIL A DRESS CITY d STATE I�pENSE NO. PHONE
,��^ Cc sli ®�XZ�G S'/ � / G(/ i( g�Z'/9/9 G92-f �4
USE OF BUILDINGa��, I R QS1&,nc e
Class of work: ANEW ❑ Auu,TION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
ahlu of fork O PLAN CHECK F7U PERMIT FEE
/Gs; '' 33/ o a
SPECIAL CONDITIONS:
BEDROOMS DECKS —o— CARPORT❑BATHROOMS NOTICE TOTAL SQ. FT. GARAGE)K9 �I S fI
NO. OF STORIES BASEMENT ❑ ATTACHED Ok SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
TOTAL SQ. FT.J81L FIREPLACE ElDETACHED ❑ OR AIR CONDITIONING.
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 am aware of the
ordinance requirements regulating the work for which FOR OFFICE USE ONLY
the permit is issued and all work done will be in
cMonfo/r'm-ance th(Qe�rewith. //�� ^' PERMANENT SHORELINES
Firm.ILJJ 6� �rOlicK l�onS/1^Utr/ ! dN /q� SEASONAL ❑ FLOODPLAIN ❑
���� D �® E.D. NO. S.E.P.A. ❑
By��J,L Ie- W1.CX Lc�
Special Approvals IN OUT YES APPROVED NO
Lic. No.-M ,ke- 13C 11112 Date '7—/``85 ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. -1-
PUBLIC WORKS
1 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. 4_
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
Owner Date APPLICATION ACCEPTED BY PLA�HECK BY APPROVED OR ISSUANCE
_ BY
PLAN CHECK VALIDATION CK, M.O. CASH PERMIT VALIDATION CK. M.O. CASH
CHRISTMASTOWN PRINTING