HomeMy WebLinkAboutBLD4060 ReRoof - BLD Application - 1/24/1979 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
C _ � /
PERMIT NO. �t✓4a
OWNER NAME MAIL ADDRESS
f 5... PO. 3 CITY&STATE Fib< k/�4— 8S�IZB' 2,7Y PH�°".sE
DIRECTIONS
TO JOB SITE _ PV0 04440 �� �F*Cr,
LEGAL
DESCR. —144er F) ,r""4 ICr� /'�M,,�f (❑SEE ATTACHED SHEET)
NAME MAIL
ADDRESS
S3 Z N//� ail l i✓W
CONTRACTOR MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
S A.MLA
USE OF
BUILDING P6S 1flE'AJ GE -• IeEn1rap eY
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
Describe work:
NEB e_OOF P.Et-toJI o-D P-ooFIA16. eEegdE D&-E,coP-A7-ED
woojo..61E *AJY) -rk6
1. Valuation of work: $ PLAN CHECK FEE
PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT❑
BATHROOMS TOTAL SQ. FT. GARAGE ❑ NOTICE
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
TOTAL SO. FT. FIREPLACE ❑ DETACHED ❑ OR AIR CONDITIONING.
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. ❑
Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DE PT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the
contract or registration law RCW 18.27, and am aware FIRE MARSHAL
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in onformance therewith.
/�_ MOTOR VEHICLE PERMIT
Owner ,Q Date, y APPLICATION ACCEPTED BY PLANS CHECK BY A ROVED FOR 1 ll NCe
P CHECK VALIDATION CK. M.O. CASH
PERMIT VALIDATION kQK. M.O. CASH