HomeMy WebLinkAboutBLD N/A Demo - BLD Application - 10/16/1981 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
332) 5426-5593DATE /�.l -
i� PERMIT NOD—I �@ �'
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OWNER ��L Q )_k, MAIL fjDDREy3[� �I7'[-C( S J� �JicL s
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-DIRECTIONS �'Y( r /'' a �? e-s.5e /,,x'c> LGt'S /r L
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LEGAL ` T/2�E'r'S � G-lnr DV'Q./'GY P-h 1;; 2 /3 / �s 4 v� a z�
DESCR. ✓;tm "` PHONE
NAME,"" MAll-ADDRESS 8 STA � LICENS,E NO.
CONTRACTOR f L`'�l� Tat
USE OF �es� cletit.G-C�- _
BUILDING U
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR C MOVE REMOVE
Describe work: DE'Sio// A — —
S-2P lic��CG� l6(�� 6 ZG1"-2
Valuation of work: $ . 00
PLAN CHECK FEE PERMIT FEE
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SPECIAL CONDITIONS:
ffBATHROOMS--
MS_ (DECKS___. —. — — CARPORT NOTICE
- TOTAL SO. FT._ __ GARAGE '. =SEPARATERMITS ARE REQUIRED FOR PLUMBING, HEATING. VENTILATING
STORIES_— BASEMENTATTACHED L_ TIONING.
O. FT._._ FIREPLACE
DETACHED J. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT (ZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER
WORK IS COMMENCED.
I certify that I am a currently registered contractor in
the State of Washington and 1 am 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 PERMANENT ' I SHORELINES '_
conformance therewith. � { f 1 r Ja/ SEASONAL'_1 FLOODPLAIN
Firm V E.D. NO. S.E,P.A. is-.
ByIN OUT YES APPROVED NO
''// Special Approvals
`��[C�L ��� �'� Date _o ZONING
Lie. No. t PLANNING DEPT,
HEALTH DEPT.
OWNERS AFFIDAVIT 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. ;"� /E r.' i /EA
of the Mason County ordinance requirements for ROAD ACCESS '
which this permit is issued and that all work done will
be in conformance therewi h. MOTOR VEHICLE PERMIT
__lA /d/S AP LIGATION ACCEPTED BY PLANS CHECK BY A$XPROVED FOR ISSUANCE
Owner
�� Date_
p CHECK VALIDATION CK. M.O. CASH
HMI] VALIDATION CK. M.O. CASH
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