HomeMy WebLinkAboutBLD15251 Mobile Home - BLD Application - 3/12/1984 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
I PERMIT NO. 144 �
NAME MAIL ADDRESS CITY 3 STATE ZIP PHONE
ih OWNER t at 75-36 )
DIRECTIONS n
TO JOB SITE Lies S00ALk 1 O-N c�+ 5+�` - 1r✓W
LEGAL (❑SEE ATTACHED SHT)
DESCR. N�r a $oGTt�em EE8 — ,f t Or �• fJj 'S�
NAME MAIL ADDRESS CITY 6 STATE LICENSE NO. PHONE
CONTRACTOR �.S_77
USE OF
BUILDING e— j L
Class of work: g NEW ❑ ADDIMON ❑ ALTERATIOK ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
0 �; Yn a t.o I 6►��
Valuation of.work: $ / �� PLAN CHECK FEE PERMIT FEE /C4. -7, 7,
i
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT❑ NOTICE
BATHROOMSS?2 TOTAL SO. 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 OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
I cert'fy that I am a currently registered contractor in WORK IS COMMENCED.
the Rate of Washington and I am aware of the ^ ` `�+
o inance requirements regulating the work for which FO OFFICE US ONLY
e permit is issued'and all work done will be in
conformance therewith. PERMANENT SHORELINES
SEASONAL ❑ FLOODPLAIN ❑
it E.D. NO. S.E.P.A. ❑
y Special Approvals IN OUT YES APPR ED NO
L . No. Date ZONING
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 DE
of ��-
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
APPLICATI N ACCEPTED BY PLA S CK BY APPROVED IN ISSUANCE
Owne Date '® B
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH