HomeMy WebLinkAboutBLD9567 Renovation - BLD Application - 6/17/1976 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 9M4 rr
DATE ISSUED -7' 96
PERMIT NO. '2�
NAME, MAIJ.ADDRESS CITY&STATE tZIP
OWNER 'Ilk I.P �'r `� ..< Lj
DIRECTIONS
TO JOB SITE � _ J j F C�.9 ,� `_ L(,� �= ° �.. ✓, �, _�� ( /�° � >�
LEGAL (❑SEE ATTACHED SHEET)
DESCR. / .c C� �{1 Q &J
NAME MAIL ADDRESS CITY 3 STATE LICENSE NO. PHONE
CONTRACTOR jNr� a,!/]
USE OF
BUILDING ��
Class of work: ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ ,it' PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS: ✓ C�
APPLICATION ACCEPTED BY PLANS CHECK BY APPRD FOR ISSUANCE Type of �f' Occupancy Division
BY / Conat. ✓/,, Group
Size of Bldg. No. of Max.
(Totai)Sq. Ft. �� Stories/ Occ. Load
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
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
HEALTH DEPT.
Firm PUBLIC WORKS
By ROAD DEPT.
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
of the Mason County Ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
nform nCe the THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
10 IS NOT COMMENCED WITHIN DAYS, OR IF CONSTRUCTION WORK IS
' SUSPENDED OR ABANDONED FOR OR T A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owner Date. WORK IS COMMENCED
PJLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH