HomeMy WebLinkAboutBLD7870 Slab - BLD Application - 12/1/1978 Q _ BUILDING PERMIT APPLICATION lid
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. r'Y}
OWNER r -re 7/ PHONE
DIRECTIONS �, t TLZ/ ��'..JJJJ!
TO JOB SITE Y G
LEGAL (❑ SEE ATTACHED SHEET)
DESCR.
NAME MAIL ADDRESS CITY&STATE LICE SE NO. PHONE
CONTRACTOR C C S — C C
USE OF
BUILDING ; ' -?r'f v S TIr,le
Class of work: X NEW ❑ ADDITION ❑ ALTEkWATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
a L
e iv C m bal , non
Valuation of work: PLAN CHECK FEE ,; �. PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT ❑ NOTICE
BATHROOMS (TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 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 f] FLOODPLAIN Ll
Firm��� 9 � Ak Srj-UC� DJ/1
E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No.10-9—0 CO-'4 S 1 G C 'dte 11,150 � 7� ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
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
of the Mason County ordinance requirements for BUILDING DEPT.
which thi ermit is issued a d that all work done will ROAD ACCESS
be in of 'an
c e w' MOTOR VEHICLE PERMIT
PPLICATION ACCEPTED BY PLANS CHECK BY APPRQVD FOR`St1ANCE
Owner Date
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION LK'.'' M.O. CASH