HomeMy WebLinkAboutBLD15265 Mobile Home - BLD Application - 3/16/1984 ` BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 .
DATE ISSUED
PERMIT NO./15526 15
OWNER NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
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DIRECTIONS +II
TO JOB SITE / aOO7W/M t S'i'c+c
i LEGAL (❑SEE ATTACHED SHEET)
DESCR. �C fi W S.. 'L�^f 4yt .�� T ^S�j i/0 4I qa
NAME MAIL ADDRESS CITY d STATE LICENSE NO. PHONE
CONTRACTOR
USE OF I l brYXR_ _ /f /
BUILDING d
Class of work: UKNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe wor
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Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT,1""ft GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES_ BASEMENT❑ OR AIR CONDITIONING.
TOTAL SO. 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 ORWORK 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 am aware of the FOR OFFICE
FFIGE USE S E ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES
SEASONAL ❑ FLOODPLAIN ❑
it E.D. NO. S.E.P.A. ❑
Special Approvals IN OUT YES APPROVED NO
1
lk . No. Date ZONING
PLANNING DEPT.
I' OWNERS AFFIDAVIT HEALTH DEPT. � y c13 �'ry�
p PUBLIC WORKS
certify that I am exempt from the requirements of the
Y FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
oI the Mason County ordinance requirements for
hich this permit is issued and that all work done will ROAD ACCESS
in conformance therew h. MOTOR VEHICLE PERMIT
a APPLICATION ACCEPTED BY jPLANSQHECK BY APPROVED FOR ISSUANCE
ate. A / GA B;" "
! K VALIDATION CK.. M.Q. CASH PERMIT VALIDATION CK. M.O. CASH ,
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