HomeMy WebLinkAboutBLD0157/#15560 - BLD Application - 5/15/1984 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
r� DATE ISSUED —
R6, ec x Y PERMIT N �� 1�•�(o O
N�E MAIL ADDRESS /+ CITY 8 STATE ZIP �PHONE
OWNER Ad-w 1no6dr one C 1411 p er caW Wzn,'
DIRECTIONS p� s� � 8ulkAiamd
TO JOB SITE R t2/� �
(❑ SEE ATTACHED SHEET)
LEGAL
DESCR. ��a�-� �vD�� G,L G PHONE
NAME MAII ADDRESS CITY 8 STATE LICENSE NO.
CONTRACTOR C49)Sir<«�(��7 �iq/{ —
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION EPAIR ❑ MOVE ❑ REMOVE
Describe work:
Re
! f.�ul - �d►
q?SOD PERMIT FEES'77
Valuation of work: $ f� PLAN CHECK E
p o
SPECIAL CONDITIONS:
c7
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑
ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SQ. 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 FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
WORK IS COMMENCED.
I certify that I am a currently registered contractor in
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 PERMANENT ❑ SHORELINES
jo �
rmance therewith. FLOODPLAIN ❑
SEASONAL ❑
Fir E.D. NO. S.E.P.A.
Special Approvals
IN O T YES APPROVED NO
By
ZONING
Lic Date
ANNING D PT
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 L DE P BUIDING
of the Mason County ordinance requirements for
which this ermit is issued and that all work done will ROAD ACCESS
be in fo mance erewith. MOTOR VEHICLE PERMIT
p �jy� APPLICATION ACCEPTED BY PLANS CH K BY APPROVED FOR ISSUANCE
Owner � Date/ //,
PLAN CHECK VALIDATION CK. M.O. CASH
PERMIT VALIDATION CK. M.O. CASH