HomeMy WebLinkAboutBLD12777 - BLD Application - 7/30/1982 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 /
DATE ISSUED
PERMIT NO.
CITY&STATE / PHONE
AME M 1L ADDRESS �EL/Y��C1
OWNER
u .
DIRECTION
TO JOB SITE G/lG j e,
_ ;r 1 fg1SEy ATTACHED SHEET)
LEGAL / # -. � �� o� a �Zq $2
DESCR. F' `/�' i 1 f� �- 612 PHONE
NAME
MAIL ADDRESS CITY&STATE LICENSE NO.
CONTRACTOR
USE OF
BUILDING �I �� �0� N ��
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERA N ❑ REPAIR ❑ MO ❑ REMOVE
Describe work: , L "oW
�'AI E i v
kjt)t.)"Vl
PLAN CHECK FEE PERMIT F r/ �j � 5
Valuation of work: $ /014 6-6 "
SPECIAL CONDITIONS:
BEDROOMS DECKS — CARPORT ❑ NOTICE
BATHROOMS �:t
OTAL SQ. FT._— GARAGE L ESEPARATE PER MITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES ASEMENT 1]
ATTACHED ❑ R AIR CONDITIONING.
TOTAL SO. FT. IREPLACE ❑
DETACHED L 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
WORK IS COMMENCED.
I certify that I am a currently registered contractor in
the State of Washington and I am aware of the F p R OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in PERMANENT [_l SHORELINES C]
conformance therewith. FLOODPLAIN ElSEASONAL ❑
Firm E.D. NO. S.E.P.A. ❑
Special Approvals
IN OUT YES APPROVED NO
By
ZONING
Lic. No. Date
PLANNING DEPT.
HEALTH DEPT. l
OWNERS AFFIDAVIT 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.
of the Mason County ordinance requirements for ROAD ACCESS
which this permit is issued and that all work done will
be. in conformance there ith. MOTOR VEHICLE PERMIT
j APPLICATION ACCEPTED BY PLANS CHECK BY BYPROVED FOR ISSUANCE
Owne f Date .�
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PLAN CHECK VALIDATION CK. M.O. CASH
PERMIT VALIDATION CK. M.O. CASH
QUARTER C OR. 1 SECS. 8 Fr 9 Tz.2 N , R 1 W W.M.
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Approved------ / ----------------------------— j L
SELLERS:
Ron & Lois Burke ,fir
East 1161 Victor Cut-Off Road Ac%
Belfair, Washington 98528
t .
SNORT PLAT OF A Pc)RT10N OF
SECTION C,,), TOWNSHIP Z2 No2TH , _
RANGE 1 VVE5T , W.M. , MASON COUNTY
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