HomeMy WebLinkAboutBLD16029 Mobile Home - BLD Application - 8/21/1984 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED �� O _
PERMIT NO.
OWNER NAME MAIL A A T TE nr /1 LP PHONE
DIRECTIONS )�1 n ,�
TO JOB SITE Or+ h i r �T
LEGAL (0 SEE ATTACHED SH ET)
DESCR. /�
CONTRACTOR NAME LO MAIL ADDRESS CITY 3 STATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: NEW ❑ADDITION ❑ ALTERATI ❑ REPAIR OVE EMOVE
bi
Describe work:
Valuation of work: S 4 PLAN CHECK,FEE PERMIT FEE
C>74)' i
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REOUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT,/,W 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 ANYTIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and i am aware of the
ordinance requirements regulating the work for which FOR OFFICE USE ONLY
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINE
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
Contract;o`r registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason .County ordinance requirements for
which this-permit Is issued and that all work done will ROAD ACCESS
b n conformance therewith. MOTOR VEHICLE PERMIT
ICA N ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Own 'to. E1 8Y
PLAN CHECK VALIDATION CK, M.O. CASH PERMIT VALIDATION CK. M.O. CASH