HomeMy WebLinkAboutBLD9305 Mobile Home - BLD Application - 1/27/1978 Please make check payable to: Mason County Treasurer
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 7 of
DATE ISSUED—
PERMIT PERMIT NO. `?J 06
OWNER NAME AT AW MAIL AD RESS CITY&STATE ZIP PHONE
s-
DIRECTIONS I 330 N. O
TO JOB SITE t S LL J 7rir��ccHE . N
LEGAL r 40W IX7 0;irr'1E of R{. N+6Y
DESCR. W NW a )VW /Uw 7 Tt4r 7 /�/
CONTRACTORi
E MAIL ADDRESS CITY&ST E LICE SE NO. PHONE
USE OF
BUILDING R[St D NC
Class of work: 11ir NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: p
Mobile Home — 20 d AIp id 0 460
D LL O = rknewq dvneg—
Lc S T " - F
Lefijq ej9,5gtXjEAT 190,40 1
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
$20.00
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PUNS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
Const. Group
Size of Bldg. No. of Maa.
(Total)Sq. Ft. Stories f• Occ. Load
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 Special Approvals Required Received Not Required
conformance therewith. ZONING
HEALTH DEPT.
Firm PUBLIC WORKS
By
ROAD DEPT.
Lic. No. Date
OWNERS AFFIDAVIT
1 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,
Of the Mason County Ordinance requirements for VENTILATING OR AIR CONDITIONING.
which this permit is Issued and that all work done will
be in conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
J� �0 SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
lA
Owne9 e4'l id6 "�.bloounate. WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
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