HomeMy WebLinkAboutBLD16233 - BLD Application - 10/8/1984 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 C
DATE ISSUED—�,l /
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
/Q [O aSure s
DIRECTIONS '
TO JOB SITE ,/07- 91 asyA e 5Aw W P moss s/ F r e
LEGAL (❑SEE ATTACHED SHEE
DESCR.
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR L�� A T e '' a -�e-.2 _9s�� -Mob"',
USE OF
BUILDING
Class of work: ANEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
I
Describe work: j
e
r �
Y C? ZO
Valuation of work: $ PLAN CHECK FEE PERWT FEE
SPECIAL CONDITIONS: �,�/ a4 rt / 77, / -7-fz WaT
BEDROOMS (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 SO. FT. FIREPLACE El DETACHED El
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 in the
aware of the FOR OFFICE USE ONLY
rdance requirements regulating the work for which
the per
is issued and all work done will be in
conformance therewith. PERMANENT ❑ SHORELINES
SEASONAL ❑ FLOODPLAIN
Firm e6l`r e0 l �'-
E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lid. o.��'R,T 1-��-.?`95 iR�• Date �r v�_� 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 BUILDING DEPT. c
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
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH