HomeMy WebLinkAboutBLD0339 Mobile Home - BLD Application - 8/27/1985 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 r
426-5593 / 7/ h
DATE ISSUED
PERMIT NO.
ME MAIL ADDRESS CITY 8 STATE ZIP PHONE
OWNER A _ �. - � dal { �� , _)2� C_!�
DIRECTIONS
TO JOB SITE
LEGAL 1
(❑ SEE ATTACHED SHEET)
DESCR
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF ''°
BUILDING
Class of rk: I%-NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE [] REMOVE
Describe work: Q
A-5
Valuation of work: $ PLAN CHECK FEE PERMIT FEE S—o
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS - TOTAL SO. FT. GARAGE ❑
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED El OR AIR CONDITIONING.
TOTAL SO. FT.I4t_•, 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 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 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 E.D. NO. S.E.P.A. ❑
Special Approvals IN OUT YES APPROVED NO
By
� �� ZONING
Li�/No. Date
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. �y
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conform=e therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLAN HECK BY APPROVE FOR ISSUANCE
Owner , ,. 6% � Yr / Date.i_t—L.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
^HRISTMASTOWN PRINTING