HomeMy WebLinkAboutBLD5144 Final Mobile Home - BLD Permit / Conditions - 11/18/1976 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 `
DATE ISSUED / �� t/
PERMIT NO.
OWNER ME MAI ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS jI of E',Gf:9�ip Qy�+tj
TO JOB SITE Cti;�C
LEGAL I (❑ SEE AIVACHED SHEET)
DESCR. Oj
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work
n
Valuation of work: $ PLAN CHECK FEE PERMIT FEE o�G 0 0
SPECIAL CONDITIONS:
LIGATION EPTED BY PLANS CHECK BY AP O�ISSUANCE Type of Occupancy Division
B Const. Group
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I certify that I am a currently registered contractor in RESIDENCE
the State of Washington and I 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 PUBLIC WORKS
BY ROAD DEPT.
Lic. No. Date
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 SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
of the Mason County ordinance requirements for 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
1 SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owned �&2�'X�ate. ig — WORK IS COMMENCED.
PL HECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
r #5144
Halvorson, D. R. II-5-76
W 2851 ' SE4 SE4 20-23-1
N. Belfair Barn
Mobile Home
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