HomeMy WebLinkAboutBLD21229 SFR BLD7869 Rec Room - BLD Permit / Conditions - 11/18/1987 - 6 .
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BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED ? /7--P
ER T 7 AV 9
OWNER AME MAIL ADDRESS CITY 3 STATE ZIP PHONE
DIRECTIONS
TO JOB SITE �� 0 /� O
LEGAL Glt�f (❑SEE ATTACHED SHEET)
Mole,/1'li
DESCR. Sep'
CONTRACTOR NAME A ! CITY STATE CENZEN'e.
USE OF
BUILDING �� C
Class of work: ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: !
C o0
Valuation of work: $ �$ PLAN CHECK FEE PERMIT FEE ,
SPECIAL C01401TIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS ' TOTAL $Q. 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 AUTHORIZED
CONTRACTOR AFFIDAVIT 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
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the FOR OFFICE' USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT ❑ SHORELINES ❑
,SEASONAL❑ FLOODPLAIN ❑
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.
PUBLIC WORKS
I certify that!am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT..
of the Mason County ordinance requirements for
whighthis_psrmi issu and that all work done will ROAD ACCESS
b in nform the th. MOTOR VEHICLE PERMIT
(CATION A EPTED BY PLANS CHECK BY APP VED FOR ISSUANCE
Owner Date. B
Ak
PLA HECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
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