HomeMy WebLinkAboutBLD N/A Cement Wall - BLD Application BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATEISSUED
WCrt/r _�� P RMIT,N
OWNER NAME MAIL ADDRESS --
CITY d STAT ZIP PHONE
DIRECTIONS _
TO JOB SITE �r S � Q t L` 1 ✓ �/
LEGAL C�
DESCR. d c Se (❑ SEE ATTACHED SHEET)
! NAME l\C
CONTRACTOR Daz (e)q MAIL ADDRESS CI 6 STATE LICENSE NO. PHONE
USE OF
BUILDING / 1
Class of wo k: ❑ NE ADDITION ❑ ALT ATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: —A
Valuation of work: $ ri o PLAN CHECK FEE
b O PERMIT FEE
SPECIAL CONDITIONS:
10
BEDROOMS DECKS CARPORT ❑
BATHROOMS TOTAL SO. FT. GARAGE ❑ NOTICE
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ 1:::E PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑ ONDITIONING.
CONTRACTOR AFFIDAVIT THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
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 am aware of the
ordinance requirements regulating the work for which FOR OFFICE USE ONLY
the permit is issued and all work done will be in
conformance therewith. PERMANENT ❑
SHORELINES ❑
Firm SEASONAL ❑ FLOODPLAIN ❑
By E.D. NO. S.E.P.A. El
tHEALTH
provals IN OUT YES APPROVED NO
Lic. No. Date
G DEPT.
OWNERS AFFIDAVIT DEPT.
I certify that I am exempt from the requirements of the PUBLIC WORKS
contract or registration law RCW 18.27, and am aware FIRE MARSHAL
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith.
MOTOR VEHICLE PERMIT
Owner Date. APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
BY
PLAN CHECK VALIDATION CK.. M.O. CASH
CHRISTMASTOWN PRINTING PERMIT VALIDATION CK. M.O. CASH
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