HomeMy WebLinkAboutBLD10035 - BLD Application - 2/10/1981 • RM1DINC P YI T APP�I ATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO., /OO �
OWNER NAME , MAIL ADDRESS GTY d STATE ZIP PHONE
p k 4a 7
DIRECTIONS r
TO JOB SITE C S
LEGAL 9 (❑SEE ATTACHED SHEET)
DESCR. t G LQQf
NAME AAAIL ADDRESS CITY 6 STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING S'
Class of work: NEW 0 AbDITIOilf ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation work: PLAN'CHECK FEE PERMIT FEE
.� Q d
SPEC L CONDITIONS:
LN
BEDROOMS P�?ECKS No ieE
CARPORT❑ � �rC
BATHROOMS TOTAL'SO. FT. GARAGE❑
7t
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED 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 ANYTIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and.;I am aware of the FOR .O F-F1 C E USE ONLY
ordinance requirements regulating the work for which
the.permit is issued and all work done will be in
conformance therewith. PERMANENT❑ SHORELINES D
ISEASONALE] FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
ZONING
Lic. No. Date
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
Ice that I am exempt from the requirements of the FIRE MARSHAL
/tb)
act or registration law RCW 18.27,.and am aware, BUILDING DEPT. -
he Mason County ordlnancq requirements for
h this permit is issued and that,all work done will D ACCESS
n conformance therewith. tMRVEHICLE PERMIT
ON A BY PLANS CHECK BY !gMP D FO ANCE
Ow -Date. (9 a ,
PLAN CHECK VALIDATION CK. M.O. CASH
PERMIT`VALIDATION CK. M.O. CASH
I