HomeMy WebLinkAboutBLD9754 - BLD Application - 7/19/1976 BUILDING PERMIT APPLICATION '� F/°
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
(� G� DATE ISSUED
PERMIT NO. 9%S
OWNER NAME MAIL ADDRESS CITY A STATE ZIP PHONE
L / �foZ/ Sed, A r se 7 Io
DIRECTIONS
TO JOB SITE
LEGAL (O SEE ATTACHED HEET)
DESCR.
NAME MAIL ADDRESS CITY 6 STATE LICENSE NO. PHONE
CONTRACTOR
U%E OF /
BUILDING /�a.,?I- C' 6r
sass of work: ❑ NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PE MIT FEE
N R �7 00
SPECIALCONDITIONS: . - -- "" - -- _-- -- - -- --
h
P CATION ACCEPTED BY PUNS CHECK B=jAPPRO.VED� SUANCE Type of Occupancy Division
Const. Group
. ei, / Jr Y l
Size of eldg. No. of Max.
(Total) Sq. Ft, cj6 0 r Storlee / Ott. Load /0
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 Spetlel Approvals Required Recei Not Required
conformance therewith. ZONING
HEALTH DEPT V
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 SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
OI the Mason County Ordinance fegUlfemBnlS (Of VENTILATING OR AIR CONDITIONING.
which this permit is Issued and that all work done will
be in c0 formance th ewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
S NOT COMMENCED WITHIN OR DAYS, OR IF CONSTRUCTION TIME
WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF ITC GAYS AT ANY TIME AFTER
Owner ^ Date. WORK IS COMMENCED.
P
,L04 CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH