HomeMy WebLinkAboutBLD215 - BLD Application - 8/21/1979 BUILDING PERMIT APPLICATION
t MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. a`�✓
ZAP PHONE
MAIL ADDRESS CITY&STATE _ G
NAME �A d
OWNER
DIRECTIONS
TO JOB SITE Ore AS ..c/ it ACHEDS ET)
LEGAL ReQ�
DESCR. LICENSE NO. PHONE
MAIL ADDRESS CITY 6 STATE
NAME
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATIOiJ REPAIR ❑ MOVE REMOVE
Describe work:
PLAN CHECK FEE PERMIT FEE aL`
Valuation of work: $ � 500.
SPECIAL CONDITIONS:
LE1111''............
BEDROOMS DECKS----
CARPORT ❑ NOTICE
BE TOTAL SQ. FT. GARAGE ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
ATTACHED ❑ OR AIR CONDITIONING.
NO. OF STORIES BASEMENT ❑ DETACHED ❑
TOTAL SQ. FT. FIREPLACE ❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT IS NOT COMMENCED WITHIN 120 GAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
WORK IS COMMENCED.
I certify that i am a currently registered contractor in FOR OFFICE USE ONLY
the State of Washington and I am aware of the
ordinance requirements regulating the work for which
the permit is issued and all work done will be in PERMANENT ❑ SHORELINES ❑
conformance therewith. _ SEASONAL❑ FLOODPLAIN ❑
_Q ..� /a /? E.D. NO. S.E.P.A. ❑
m - IN OUT YES APPROVED NO
WY a� o+�(� Special Approvals
ZONING
Lic. No. Date PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT PUBLIC WORKS
I certify that 1 am exempt from the requirements Of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for ROAD ACCESS
which this permit is issued and that all work done will
be in conformance therewith. MOTOR VEHICLE PERMIT
ICATION ACCEPTED BY PLANS CHECK BY BY/ I ISSUANCE
Owner Date
PERMIT VALIDATION CK. M.O. CAS
PLAN CHECK VALIDATION CK. M.O. CASH
THIS "PARCEL.
INCLUDES
PLANS, BLUEPRINTS
O. R OVERSIZE
IMAGES - ,
LARG E ' FO RMAT
IMAGES HAVE BEEN STORED IN
FILE CABINETS) UNDER
PARCEL NUMBER
PARCEL # iaao6 - 441
CASE #