HomeMy WebLinkAboutBLD0158/15561 - BLD Application - 5/15/1984 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATEISSUED Q� —
PERMIT NO. �l s u Z-5,6
OWNER NAME O MAIL ADDRESS S STATE ZIP �5 N2L_�
DIRECTIONS �(/ aZ /� I�-«� ,�1,�/• J
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. IS�a /O (s'.,L 3 A, � — BS
NAM v MAIL AD ESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR '6 7 , �L //Z ,vE�.�i� Glj�, ,�
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ElMOVE ❑ REMOVE
Describe work:
84,' 1- 1< ,A =/9
—
o
Valuation of work: $ PLAN CHECK KEE PERMIT FEE Sid
SPECIAL CONDITIONS:
BEDROOMS {DECKS CARPORT ❑ NOTICE
BATHROOMS 1 TOTAL SO. FT. GARAGE ❑
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ 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 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 aware of the FOR OFFICE USE ONLY
ordi ance requirements regulating the work for which
the/permit is issued and all work done will be in
c formance therewith. PERMANENT ❑ SHORELINES
SEASONAL El ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. Date ZONING
PLANNING D
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 ILDING DEPT
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance the ewith. MOTOR VEHICLE PERMIT
I APPLICATION ACCEPTED BY PLANS C K BY PPROVED FOR ISSUANCE
OW f a e. BY
PLAN CHECK VALIDATION CK. .O. CASH PERMIT VALIDATION CK. M.O. CASH