HomeMy WebLinkAboutBLD9372 - BLD Application - 5/5/2009 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Wasnington 93584
DATE ISSUEO_�fi'- � l '
PERMIT NO. %
rDIRECTIONS
NAME MAIL ADDRESS CITY a STATE ZIP PHONE
%
/ / / .�
SITE , S!?d C� d exc: " *c L e'-f'r r '5Ids_ he&�C` 4/eVS1c./ieeo a14
LEGAL rr , ;� �i�vr.fs (❑ HED SHEET SEE ATTA )�•f�••--
L FT�rr��
DESCR.
',n $Pv 41
S� S OkL♦
NAME MAIL ADDRESS CITY R STATE LICENSE O. PHONE
CONTRACTOR
USE OFy
BUILDING �c vo G RP ,`o t� tt ��• 7S �G��
Class of work: >(NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: e .1 / --
Y d c,
Valuation of work: $ r PLAN CHECK FEE PERMIT FED
SPECIAL CONDITIONS: s
t- 1411/�Vr Ace
APPLICATION ACCEPTED BY, PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
¢/ -! Y Ae''ef-.p_{_.10'--' Const. Group
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I certify that 1 am a currently registered contractor In RESIDENCE
the State of Washington and 1 am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
( HEALTH DEPT.
Firm C4 • .r C"c 4•s PUBLIC WORKS
By ROAD DEPT.
Lic. No. �' _ 3 Z Q�Date Z
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be in conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
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
vner Date. WORK IS COMMENCED.
,N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION M.O. CASH