HomeMy WebLinkAboutSchool Bldg - BLD Application - 6/3/1982 .BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL DDRESS CITY It STATE ZIP PHONE
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DIRECTIONS
TO JOB SITE
LEGAL (❑SEE ATTACHED SHEET)
DESCR.
CONTRACTOR
NAME MAIL ADDRESS CITY d STATE C?PS9 J LICENSE NO. PHONE
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C/ P Q ,;, %&.z c/o-/Yt-SR- c8}q 45-C 431i
USE OF
BUILDING CI
Class of work: kNEW ❑ ADDITION ❑ ALTERATION . ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ 6 E/ �_ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIO j'
1 -
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
NO. OF STORIES BASEMENT ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SO. FT. 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 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 ❑
�j Firm SEASONAL ❑ FLOODPLAIN ❑
�'-s � �"-
E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPR VED NO
Lic. No. C7 �L- �� Cgl9 Date C-3 ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
I PUBLIC WORKS L
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.
which this permit is issued and that all work done will ROAD ACCESS A ff A I ` L evw
be in conformance therewith. MOTOR VEHICLE PERMIT
Owner Date.
APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE
BY�
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
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