HomeMy WebLinkAboutBLD4030 Mobile Home - BLD Permit / Conditions - 1/26/1977 p o n W
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�- `BUILDING PERMIT APPLICATION I
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATEISSUED
PERMIT NO. G
MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER EZ'JMEA mp-A
DIRECTIONS t S BOYS
TO JOB SITE
(❑ SEE ATTACHED ET)
LEGAL (+ C
DESCR. S� ) PHONE
NAME
MAIL ADDRESS CITY&STATE LI NSE NO.
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work
PLAN CHECK FEE PERMIT FEE '2
Valuation of work: $ cad
SPECIAL CONDITIONS:
Occupancy Division
ICATION A Const EPTED BY PLANS CHECK BY AYP V FOR ISS NCE Type . 7 Group
� //
Size of Bldg. No. of Max. /i/
(Total) Sq. Ft. Stories Occ. Load !d
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.
PUBLIC WORKS
Firm
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 REQUIRED 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 I OnfOrmanCe therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
7/ SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owne '� �/ Date, (9 WORK IS COMMENCED.
PL CHECK VALIDATION CK. M.O. CASH
PERMIT VALIDATION K. M.O. CASH
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