HomeMy WebLinkAboutBLD9387 FINAL, LIFE SAFETY ONLY. - BLD Permit / Conditions - 9/5/1980 BUILDING PERMIT APPLICATION
` MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 -
DATEISSUED
PERMIT NO.
CITY&STATE ZIP PHONE
NAME MAIL ADDRESS �, _��907
OWNER p, o9G P-5�
DIRECTIONS z ✓�� z ��
TO JOB SITE (❑SEE ATTACHED SHEET)
LEGAL i cy� �/ ' � .� ��, -r. ..• �a
DESCR. 70 /GO• �! LICEN ENO. PHONE
NAM MAIL ADDRESS CITY&STATE
CONTRACTOR
USE OF
BUILDING -f �RE,4 A-Alb FXTe%Sto� T y
Class of work: ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
e, t ,�LDCK ol�'� �v P�is'
„` tPLA;N>CLECK FESO �C ERMIT FEE
Valuation of work: $
...
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L CONDITI NS:
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BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
ATTACHED ❑ OR AIR CONDITIONING.
NO. OF STORIES BASEMENT ❑
TOTAL SO. FT. DETACHED ❑FIREPLACE ❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT 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
WORK IS COMMENCED.
I certify that I am a currently registered contractor in
the State of Washington and I am 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 PERMANENT ❑ SHORELINES ❑
conformance therewith. FLOODPLAIN ❑
SEASONAL ❑
E.D. NO. S.E.P.A. ❑
Firm IN OUT YES APPROVED NO
Special Approvals
By
ZONING
Lic. No. Date
PLANNING DEPT.
HEALTH DEPT.
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 !
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
ATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owne ate. �
PLAN CHECK VALIDATION UK. M.O. CASH
PERMIT VALIDATION CK. M.O. CASH
Morgan, Marjorie ,A. #9387
10-9-79
S. 70' N 140' G. L. 3 21-22-1
1,000' North of Victor Fire Station
Star Route 4, Box 258, Belfair
Alteration & Addition
$4,906.00
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