HomeMy WebLinkAboutBLD4159 Remove Rotted Box Sill and Addition - BLD Application - 2/16/1979 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. /1
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
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DECR. G I S�• t /� /G SO l� �� C ,CiC� S /A A& �/ �, `�� �S
NAME MAIL ADDRESS CITY&STATE LICENSE NO, PHONE
CONTRACT _
USE OF
BUILDING �?
Class of work: NEW ❑ ADDITION ❑ TERATION AL REPAIR ElMOVE El REMOVE
Describe work:
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Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIA1 CONDITIONS:
BEDROOMS {DECKS CARPORT ❑ NOTICE
BATHROOMS I TOTAL SQ. FT. GARAGE L
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT CI ATTACHED Li OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE Lj DETACHED Ll
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT 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 the
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
conformance therewith. PERMANENT SHORELINES
'L SEASONAL11 FLOODPLAIN
Fi E.D. NO. S.E.P.A. l
B Special Approvals IN OUT YES APPROVED NO
y
Lic. No.. �� G. A/Date Q ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
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.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APfROVED FOR ISSUANCE
Owner Date .
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K. M.O. CASH