HomeMy WebLinkAboutBLD9975 ReRoof - BLD Permit / Conditions - 8/20/1976 ,�.BdllDWG PE IT APPLICATION S&diT
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED O a�
PERMIT NO.
ow-Haut].
pIM1E MAL ADDR4t CIN i STATE ZIP PHONE
i softsosth of P*Ue'access
sf e - WLT—ftv beft". lie access icett ftb" to W"
LMQAL (❑SEE ATTAW0 SHEET)
See. 21 aww 5 use 6 at Bast as or
C11MITRAflTOA �M ,11 MAL A11101111110 rxry i STATE LImE NO. PHONE '
UK
WALl"M `
Class of work: ❑ MEW` 0 A0011"ON ❑ ALTERATION X REPAIR ❑ MOVE ❑ REMOVE
Describe work:
12R04 Vilifto0 "of
Vsfuatk►s of work: $ 3�► PLAN CHECK FEE PERMIT FEE
t I
RLANd any r tIYMANeE Type at o.ouvemy Division
c o*, amp .T
$W.of skip. me. of Max.
(TOW)Sq. Ft. Starts Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
1 certify that I am a currently rooistererl contacteir in 14111111IDENCE
the State of Wa IklirNjton,artd I Gen aWarer of the M06U HOME
4-
ordinance requirement®Viating the work for which
the permit is issued and A11'work done will be in taw Approvals Required ReoNved Not Required
conformance therewith. ZONING
H"t an CON" I �e l ALTH DEPT.
=irm PUBLIC WORKS
By ROAD DEPT.
Lic. No. �� Date OWNERS AFFIDAVIT
AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, 0 am aware
of the Mason County oroin8ktae regu romentaf for SEPARATE PERMITS ARE FW
4IRED FOR ELECTRICAL, PLUMBING, HEATING,
which this permit is issued and that all work done will VENTILATING OR AIR CONDITIONING
be in conformance therewith. THIS PERMIT eEOoME$NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
0 -NOT COW"I"Was.WITMN 1JO DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED on AbAwmaD FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owner WORK IS COMMENCED.
M.O. CASH
PLAN HECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK.
i
i
8-20-76
11-21-5 Trac 6 E# SEJ
Lost Lake Road
I
Re-root
$360.00
Sl 11 q/ t�ob�