HomeMy WebLinkAboutBLD12574 4' Walk - BLD Application - 6/15/1982 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER E MAIL ADDRESS CITY 8 STATE ZIP PHONE
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DIRECTIONS
TO JOB SITE
(❑ SEE ATTACHED SHEET)
LEGAL "
DESCR. v 7
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
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Class of work: ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
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Valuation of work: $ PLAN CHECK FEE PERMIT FE�
SPECIAL CONDITIONS:
BEDROOMS DECKS 77PPIZ7 CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT.__ GARAGE ❑
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ 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 Cl SHORELINES
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
Special Approvals IN OUT YES APPROVED NO
By
Lic. No.—
Date ZONING
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.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in c nformance therewith. MOTOR VEHICLE PERMIT
'— APPLICATION P Ed BY PLANS CHECK BY APPROVED FOR IS UANCE
Ow er
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41
P CHECK VALIDATION CK. M.O. CASH ERMIT VALIDATION K. M.O. �ASI
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