HomeMy WebLinkAboutBLD13645 Addition - BLD Permit / Conditions - 2/28/1983 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426.5593 aA �/�-3
DATE ISSUED_—, l
PERMIT NO. / c36 yid
OWNER NAME MAIL ADDRESS CITY d STATE ZIP PHONE
11
DIRECTIONS
TO JOB SITE 3
LEGAL i (❑ SEE ATTACHED SHEET)
DESCR. Q— /
NAB MAIL ADDRESS CITY&STATE LICENSE NO: PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW KADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: r
d-b
Valuation of work: S PLAN CHECK FEE PERMIT FEE
4
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
ATTACHED C� SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT FIREPLACE ❑ DETACHED C7
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 160 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 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
El
SEASONAL 0 FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A.
j By Special Approvals IN OUT YES APROVED
NO
t
Lic. No. Date ZONING
j PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that 1 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 is permit is Issued and that all work done will ROAD ACCESS
be onformance therewith. MOTOR VEHICLE PERMIT
AP 14 �� ICATION ACC PIED Y PLANS CHECK BY ROVED FOR 1 UANCE
Owner Dat
PL CHECK VALIDATION CK.. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
PV
Clark, Joan #13"5
426-9528 2/26/83
31-20-3, Tract 2, NE 1/4, NW 1/4
1/4 mile left off of W 310 Clark Road
Addition Contractat:
224 Sq. Ft. Same
$6,720.00
0
.. � �
8 rM44