HomeMy WebLinkAboutBLD10814 - BLD Application - 6/18/1981 ,. BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
—
DIRECTIONS
TO JOB SITEH410-5-TWIL- !.n. ir- be. --
s: .Al
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. - � r � — r-- �
CONTRACTOR
NAME A IL DD ESS CITY&STATE LICENSE NO. PHONE
—..? � t _ — "t/ F 51
a
USE OF
BUILDING - r
Class of work: ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
L
Valuation of work: PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIO /
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
TTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT)4�! 1 OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ l/ ETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFID VIT 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 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
w SEASONAL ElFLOODPLAIN ❑
Firm134,96 � alCI�i9t� E.D. NO. S.E.P.A. ❑
By �„� �� Special Approvals IN OUT YES APPROVED NO
` ZONING
Lic. No. 7,�.�y(,�i- z'�(�� �'" Date
1 4 ANNING DEPT. 8 /
OWNERS AFFIDAVIT HEALTH DEP .
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
PPLI TION EPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
O ner Date. Z BY
_.P2
LAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH