HomeMy WebLinkAboutBLD10139 - BLD Application - 3/4/1981 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED 3
PERMIT NO.
NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
JWNER S7aA�T 4;/OOES /000 Z J¢T~ tLUI� 98 37/
DIRECTIONS
TO JOB SITE NOOE.S— As/4= T.mAcT 0a!�/E
LEGAL O /40AI O O L.O E /$ 2 / (11
SEE ATTACHED SHEET)
DESCR. IQGF /A/. DCUL' . As %,rACT A•oL .SNoreT P1J97-VAIDEr- -3;IIVO
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR 16-01-4011111/6CDP—p
USE OF
BUILDING �OB/L f�0/�gE CG✓E
Class of work: RINEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
EEL SSG O/!f/G/�
Valuation of work: $ O U _ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS — f DECKS CARPORT ii NOTICE
BATHROOMS 1 TOTAL SQ. FT. GARAGE 'i_i
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT I] ATTACHED i_1 OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE i ', 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 the
aware of the FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES
�� ��• .,t/ SEASONAL FLOODPLAIN
Firm t�/�/G L�
By<� �1 E.D. NO. S.E.P.A.
�l!j _ Special Approvals IN OUT YES APPROVED NO
Lic. No 60_ D20lo�P Date — — / ZONING
f
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. sr y
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. OTOR HICLE PERMIT
A LICATI AC D Y PLANS CHECK BY APPROVED FOR ISSUANCE
Owner __ Date . x BY
CK
LAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION M.O. CASH