HomeMy WebLinkAboutBLD128 Mobile Home - BLD Permit / Conditions BUILOING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426.5593 _
DATE ISSUED '-
PERMIT NO.
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AME MAIL ADDRESS CI 8 S T LP PHONE
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Class owork: � NEW O ADDITION ❑ A TER TION ❑ REPAIR ❑ MOVE ❑ REMOVE
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Describe work: / '7— r
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Valuation of work: $ Z s/ QUQ PLAN CHECK FEE PEF MIT FEE aO. r-d SPECIAL CONDITIONS.
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS -I— TOTAL SO. FT. GARAGE ❑ VENTILATING
SEPARATE PERMITS ARE REQUIRED FOR PLUMB( G, HEATING,
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SO. FT.6 FIREPLACE❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT IS NOT COMMENCED WITHIN 120 DAYS, OR IF CC NSTRUCTION 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 FOR OFFICE US ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES ❑
LA
SEASONAL ❑ FLOODPIN ❑
Firm E.D. NO. S.E.P.A. ❑
BY Special Approvals IN OUT YES APPROVED NO
Lic. No. Date 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
APP1,ICATION ACCEPTED BYL PUNS CHECK BY APPROVEDFOHISSUANCF!
Owne.//�7 r4-t-f-G�bate. zfff
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION ,CK. M.O. CASI'
Mooers, Robert E. #128
9-19-79
Erickson Short Plat Lot #2 G. L. 7 32-21-2
2nd driveway to right past Spencer Lake public
access going north on Spencer Lake Road.
Mobile Home
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