HomeMy WebLinkAbout4544 - BD General - 4/1/1977 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATEISSUED Z 7 7
PERMIT NO.
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNERLA —D
DIRECTIONS
TO JOB SITE
LEGAL -5ec (❑SEE ATTACHED SHEET)
DESCP. a
MAIL ADDRESS CITY S STATE LICENSE NO. PHONE 1
CONTRACTOR[TH,E Il N t '
�
USE OF
BUILDING '
Class of work: ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE j o PERMIT FEE
SPECIAL CONDITIONS!
AeLICATION ACCEPTED B CHECK BY F ANCE TyPe of Oocup�y Division
Al�j BY - Const. .rJ" Group 3
sins of slog.'1L No. of Max.
(Total)Sq. Ft. /�/� Stories ( Occ. Load l 0
CONTRACTOR AFFIDAVIT PERMANENT SEASONAL E.D.NUMBER
I certify that I am a currently registered contractor in RESIDENCE
the State of Wastdogtotl and I am aware of the MOBiIHOME
ordinance requirements mQuIstinq the work for which Approvals R�quirod Rs�ived Not Required
permit is issued and all work done will be in
conformance therewith. ZONING
r H LTH DEPT. .� Z'
Firm PUf3t WORKS
ROAD DEPT.
ey
Lic. No.<� -1 AN 19 r?I'q:3f3� Date
OWNERS AFFIDAVIT
N
s I certify that I am exemptfrom the requirements of the N O T I C E
contract or registration_law RCW 18.27,jp am aware, SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
of the Mason County -ordinance re4olwnents for VENTILATING OR AIR CONDrnONING.
which this permit is issued end that all work done will
be in conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMtrIENCEO#I*'H ! J20 DAYS, OR IF CONSTRUCfiION�OR WORK IS
"tl SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owner Date. WORK IS COMMENCED.
a
NCHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
L
DD '
v
Sinnitt, Paul #4 4 _
4-1-77
Hartstene Island
Lot 2 36-20-2
1,
�,........: Addition
$8 000.00
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