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HomeMy WebLinkAboutBLD0188 Mobile Home - BLD Application - 6/26/1984 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 0 G �iL11 DATE ISSUED PERMIT NO. ©� OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE DIRECTIONS I A,d'dSj� TO JOB SITE LEGAL (❑SEE ATTACHED SHEET) DESCR. NAME MAIL ADDRESS CITY a STATE LICENSE NO. PHONE CONTRACTOR s USE OF BUILDING Class of work: +MNEW ❑ 40bITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: Valuation of work: $ d PLAN CHECK FEE PERMIT;FEE yg 13d SPECIAL CONDITIONS: BEDROOMS DECKS CARPORT ❑ NOTICE BATHROOMS_ TOTAL SQ. FT._ GARAGE ❑ ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIE r BASEMENT❑ OR AIR CONDITIONING. TOTAL SO. FT FIREPLACE ❑ DETACHED ❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER I certify that I am a currently registered contractor in WORK IS COMMENCED. the tat of Washington and I am aware of the FOR O-FFIC'E USE ONLY obi ance requirements regulating the work for which th permit is Issued and all work done will be in C formance therewith. PERMANENT ❑ SHORELINES ❑ SEASONAL❑ FLOODPLAIN O Fir E.D. NO. S.E.P.A. ❑ By Special Approvals IN OUT YES APPROVED NO Lic. No. Date ZONING PLANNING DEPT. OWNERS AFFIDAVIT HEALTH DEPT. PUBLIC WORKS I certify that I am exempt from the requirements of the FIRE MARSHAL contract or registration law RCW 18.27, and am aware BUILDING DEPT. L of the Mason County ordinance requirements for which this permit is Issued and that all work done will ROAD ACCESS be in conformance therewith. MOTOR VEHICLE PERMIT ��I 6"�6.8i� APPLICATION ACCEPTED BY PUN HECK BY APPROVED F ISSUANCE Owl ems(\��C o/'���o"rr J� Date. eY c�� / Gn-.Ci mAl PL N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH