HomeMy WebLinkAboutBLD77-5998 - BLD Permit / Conditions - 9/27/1977 BUILDING PERMIT 'APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington
98584
ISSUED ��LL1�
(� PERMIT NO.
OWNER NAME MAIL A DRES CITY&STA 21P PHON _
DIRECTIONS TO JOB SITE D
LEGAL (',S Z) $w 5L?` (❑ SEE ATTACHED SHEET)
DESCR. E /O 1
NAME MAIL ADDRESS U ATE LICENSE NO. PHONE
CONTRACTOR
USE OFF,.
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: , r
Valuation of work: $ �- PLAN CHECK FEE �- s�0 PERMIT FEE
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY1 PLA CHECK BY JAUPP ED��SUANCE Type of Occupancy Division
CC Const� j Group
eOL4/l�,C `/L'
Size of�ldg. No. of Max.
(Total) q. Ft. Stories 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
I 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
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be In formance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
> IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
^OW L' Date, 7 7 WORK IS COMMENCED.
N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K. M.O. CASH