Loading...
HomeMy WebLinkAboutBLD16143 - BLD Application - 9/19/1984 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 , I g�-- DATE ISSUE � — I PERMIT NO. OWNER NA AIL ADDRE S CITY&STATE ZIP PHONE Qo. x c v\ 4.� �4s�. a_)s433 DIRECTIONS A ��� 3 T11,0 IT© C TO JOB SITE �G45o v�a�J mood LEGAL �� / (❑ SEE ATTACHED SHEET) DESCR. �Qe"' �Q 3' NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE CONTRACTOR USE OF BUILDING 0300d �3 { © 0 Class of work: 2& NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: q� �� woad �v� Valuation of work: $ PLAN CHECK FEE PERMIT FEE / ------------ SPECIAL CONDITIONS: BEDROOMS DECKS CARPORT ❑ NOTICE BATHROOMS TOTAL SQ. FT. GARAGE ❑ ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES BASEMENT ElOR AIR CONDITIONING. TOTAL SO. FT. 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 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.40. Date ZONING PLANNING DEPT. OWNERS AFFIDAVIT HEALTH DEPT. PUBLIC WORKS I certify that I 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 which this permit is issued and that all work done will ROAD ACCESS be in conformance therewith. MOTOR VEHICLE PERMIT l l•$ LIC N ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Owner Date. BY PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH