HomeMy WebLinkAboutBLD9961 Enclosed Porch - BLD Application - 8/17/1976 le- //e C-
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
(21
DATE ISSUED 7 7
PERMIT NO. g�—
( (NAME i MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER W,�'1?D / L
x DIRECTIONS
` TO JOB SITE 6 ae-r ro6,;, oF M q;rLo r fit: STr,P
C (❑SEE ATTACHED SHEET)
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NAME MAIL ADDRESS
CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING _
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
PLAN CHECK FEE PERMIT FEE
Valuation of work: $
SPECIAL CONDITIONS:
u• c�
Occupancy Division
APPLICATION ACCEPTED BY1 PLANS CHECK BY A ROVEQ F R ANCE Type of /onst. Group /)
� y
No. of Max.Size of Bldg.
(Total) Sq. Ft. Stories Dec. 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 Special Approvals Required Received Not Required
the permit is issued and all work done will be in ZONING
conformance therewith.
HEALTH DEPT.
Firm PUBLIC WORKS
ROAD DEPT.
By
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 REOUIRED 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
X Arf /�.,�SUSPENDED OR ABANDONED FOR A PERIOD OF 12D DAYS AT ANY TIME AFTER
rL_Date / WORK Is COMMENCED.
Owner
P CHECK VALIDATION CK. M.O. CASH
PERMIT VALIDATION CK. M.O. CASH