HomeMy WebLinkAboutBLD12630 Mobile Home - BLD Application - 6/28/1982 N ire I 1 PP IC&TION
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MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 .L
426-5593
DATEISSUED
PERMIT NO. ��
OWNER NAME MAIL ADDRESS 017f 1,STATE e ZIP PHONE
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DIRECTIONS � •G �+�C "d _
TO JOB SITEZ.C�
LEGAL ? (❑SEE ATTACHED SHEET)
DESCR. OC — / ��(/-f. o� K'J
NAME MAIL ADDRESS eITY 3 STATE LICENSE NO. PHONE
CONTRACTOR
USE OF XeSi-deA c,e-
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: _
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Valuation of work: $ 'Aa 4-4--al PLAN CHECK FEE PERMIT FEE
;�9• s s
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF.WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZEp8NOTOOMMIBDWITHIN180DAY>B4ORIF CONSTRUCTION OIWORKIS
SU DED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
1 certify that I am a currently registered contractor in WORKIS COMMENCED.
,the State of Washington and I am aware of the
ordinance requirements regulating the work for which 1= Glf FIGS U ONLY
the permit is issued and all work done will be in
Conformance therewith. PERMANENT SHORELINES 61 U
SEASONAL O FLOOOPLAIN ❑
Firm E.D. NO S.E.P.A.❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. `Z,�•
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and aryl aware BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be onformance therewith. MOTOR VEHICLE PERMIT
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A BY PLANS CHECK BY APP ISSUANCE
Owner Date.
PIJ�h CHECK VALIDATION CK. M.O. CASH PIMMIT VALIDATION CK. M.O. CASH