HomeMy WebLinkAboutBLD2811 Mobile Home - BLD Application - 12/27/1978 AW-
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BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED �07- '1 W
PERMIT NO.
OWNE2SITE
AME ,C , L��u icy< p�MAIL ADDRESS CITY&STATE ZIP
PHONE
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DIRECo v,t R t'��/ r a r I=I v e S 7-,i I c +. (�1 r L k L I ,, e,� ci -
TO JO �� �l , /�mac,, 1 r h
LEGAL zJjIS i .�, o lL �/< L i wry e��i�/ (❑ SEE ATTACHED SHEET)
DESCR 3 Y e c�;v�,t�d 1" /-4< A
v o 7r✓ ,. G ) P, s
CONTRACTOR NAME MAIL MAIL ADDRES CITY&STATE LICENS O. PHONE
USE OF
BUILDING r t
Class of work: ANEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
O 2
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS-_� DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE El
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ ESEARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑
CONTRACTOR AFFIDAVIT THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
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 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 ❑ SHORELINES ❑
Firm
SEASONAL ❑ FLOODPLAIN ❑
By E.D. NO. S.E.P.A. El
Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. Q
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
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith.
��,,�, MOTOR VEHICLE PERMIT
O""ef ate. �//u/'7 7_ APPLICATION ACCEPTED BY PLANS CHECK BY PROVES FOR I A�ICE
i222;Zl"I.-, -
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH