HomeMy WebLinkAboutBLD8393 - BLD Application - 8/27/1975 BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584
DATE ISSUED__Q-a 7" 76' —
PERMIT NO
T- --- MAIL FDOR ESS !1 ^�-� Q p 0-
PHONE
OWNER __— Z ��o�c —�3S 2'/�1*'�7
DIRECTIONS
TO JOB SIT
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M IL ADDRESS ZIP
�E`(AL .T� (oSEE ATTACHED SHEET)
DESCR. �-5 e /V
MAIL ADDRESS PHONE
COTRACTOR S�
fU'SE Of MAIL ADDRESS PHONE LICENSE NO.
ILDING �v
Class of work: ❑NEW ❑ADDITION O ALTERATION REPAIR O MOVE O REMOVE
Describe work:
Valuation of work:$ PLAN CHECK FEE PERMIT FEE
- ,
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECKED BY APPRO�VED FpR ISSUANCE BY
!1 _ Type of Occupancy
weC/ Const. Group Division
Size of Bldg. No.of Max.
(Total)Sq.Ft. Stories Oct.Load
CONTRACTOR AFFIDAVIT Special Approvals 7Raqul Received Not Required
I Certify that I am a currently registered contractor in the State
of Washington and the County of Mason and I am aware of the HEALTH DZIRT,
ordinance requirements regulating the work for which the permit TsUBLIC WORRG
Is issued and all work done wi11 be in conformance therewith. DIMPT,
Firm
By
Lic. No. Date
OWNERS AFFIDAVIT
1 certify that I am exempt from the requirements of the contract _
or registration law RCW 18.27, and am aware of the Mason N 0 T I C E
County ordinance requirements for which this permit is issued
and that all work done will be in conformance therewith. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING,
HEATING. VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC-
TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF
Owner Date O��- i, 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PLAN CHECK VALIDATION cK M.o. CASH PERMIT VALIDATION cK. M.O. CASFI"
SHELTON PRINTING CO.
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