HomeMy WebLinkAboutBLD11510 Foundation - BLD Permit / Conditions - 9/30/1981 APPLICATION
BUILDING PERMIT
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 9.3� r ��
w 426-5593
DATE ISSUED
PERMIT NO.
' ZIP PHONE
MAIL ADDRESS CITY 6 STATE (�
j NAME ^ J
OWNER
DIRECTIONS
TO JOB SITE en , i SEE ATTACHED SHEET)
LEGAL /V 7r�Qrt�� (�► w l 1, 15,1 � C •Q,�. 6t�a
DESCR. ��� 1 S T CITY 6 STA LICE NO.
NAME PHONE
MAIL ADDRESS TE
CONTRACTOR 1 � Cw
USE OF �S BUILDING
Class of work: ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
iY
V:op-., Q
rk: $ PLAN CHECK FEE �
Valuation of wo /�O/ � PERMIT FEE
SPECIAL CONDITIONS:
CARPORT ❑ NOTICE
BEDROOMS DECKS VENTILA
I BATHROOMS TOTAL SO. FT._-- GARAGE ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING,
ATTACHED ❑ OR AIR CONDITIONING.
NO. OF STORIES BASEMENT ❑TOTAL SO. FT. FIREPLACE ElDETACHED ❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHO�
I CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN'180 DAYS,OR IF CONSTRUCTION OR WORK
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTE fi
WORK IS COMMENCED.
i
I certify that I am a currently registered contractor In FOR OFFICE USE ONLY
i the State of Washington and I am .aware of the
ordinance requirements regulating the work for which
the permit is issued and all work done will be in PERMANENT ❑ SHORELINES ❑
conformance therewith. SEASONAL ❑ FLOODPLAIN ❑
coal y.}+ . • E.D. NO.- S.E.P.A. ❑
Firm ` ,� p IN
OUT YES APPROVED NO
Special Approvals
BY ZONING
Date
Lic. No. PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT PUBLIC WORKS
i certify that I am exempt from the requirements of the FIRE MARSHAL111,11
contract or registration law RCW 18.27, and am aware
BUILDING DEPT. f qua
3 of the Mason County ordinance requirements for ROAD ACCESS
which this permit is Issued and that all work done will MOTOR VEHICLE PERMIT
be in conformance therewith. APPROVED FOR ISSUANC
PLICATION ACCEPTED BY PLANS CHECK BY
Date.
Owner
PERMIT VALIDATION K. M.O. CASH
P N CHECK VALIDATION CK.. M.O. CASH
i • ;
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Twidwell, Jerry (Gerald) - #11510
9/30/81
Sec. 15-21-4, Tract 12 of NW 1/4 of SW 1/4,
Except Right of Way
Rourgault Road, Skokomish Valley (Green House)
_ Foundation Contractor;
A j $1001.00
Thomas R. Willson
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