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HomeMy WebLinkAboutBLD9551 - BLD Application - 3/13/1978 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 DATE ISSUED 6.5-1"1/ PERMIT NO. OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE DIRECTIONS TO JOB SITE LEGAL , (❑ SEE ATTACHED SHEET) DESCR. 9 NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE CONTRACTOR ��- C©ns o?O/r��Ele�t S1' t+�� Ii , C �li) USE OF BUILDING '.,, V Wyk Class of work: ❑ NEW ItADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: t � � l� Valuation of work: $ PLAN CHECK FEE PERMIT FEE SPECIAL CONDITIONS: APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Type of / Occupancy n Division BY Const. /, Group Size of Bldg. No. of Max, (Total) Sq. Ft. Stories Occ. Load i1 CONTRACTOR AFFIDAVIT PERMANENT SEASONAL E.D.NUMBER I certify that I am a currently registered contractor in RESIDENCE the State of Washington and I am aware of the MOBILE HOME ordinance requirements regulating the work for which the permit is issued and all work done will be in Special Approvals Required Received Not Required conformance therewith. ZONING HEALTH DEPT. L/ Firm 04nd. PUBLIC WORKS BY ROAD DEPT. �qf Lic. No. h. c7 Date OWNERS AFFIDAVIT I certify that I am exempt from the requirements of the N O T I C E contract or registration law RCW 18.27, and am aware of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. which this permit is issued and that all work done will be in conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER OW er Date. WORK IS COMMENCED. 07 PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK M.O. CASH