HomeMy WebLinkAboutBLD4879 SFR - BLD Application - 8/23/1976 BUILDING PERMIT APPLICAT10i
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED 2z
PERMIT NO. 4 cF 7 q
OWNER NAME MAIL ADDR SS CITY&STATE,,,,,",, ZIP PHONE
DIRECTIONS
TO JOB SITE � c ►,r , s 6 a Z Z T 111 rn r f
LEGAL (❑SEE ATTACHED SHOT)
DESCR. C- '2 N lliC� z�J S
f
AME MAIL A RESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR /e
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: //
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY JAPP Type of Occupancy Division
BConst. Group
Size of Bldg. & 74 4p No. of Max.
(Total)Sq. Ft. Stories Z Occ. Load d
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
con ormance therewith ZONING
HEALTH DEPT.
Firm �—✓�� PUBLIC WORKS
By ,{� ROAD DEPT.
r
Lic. No. G u'CE-7L4-,FaV cpey 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
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owner Date. WORK IS COMMENCED.
VPLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH