HomeMy WebLinkAboutBLD6469 - BLD Application - 5/22/1980 BUILDING PERMIT APPLICATION
MASON COUNTY
1P.0.7186 Shelton, Washington 98584
426-5593 -ry
DATE ISSUED '� 4 =�
CJ PERMIT NO.
OWNER MAIL ADDRESS � G CITY .1 AVJ L 21P ��� PHONE
DIRECTIONS
TO JOB SITE
LEGAL /� (❑SEE ATTACHED SHEET)
DESCR. '� / CC r� D T
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRA TOR
r
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
1
r c
6-epldcz 2C
+C
Valuation of work: $ PLAN CHECK FEE -4 PERMIT FEE
i
SPECIAL CONDITIONS:
s' VIVO
BEDROOMS DECKS CARPORT [] NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE L
ATTACHED f� SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT [] OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE [I DETACHED [1
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT 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
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT 1.1 SHORELINES I 1
SEASONAL 1 1 FLOODPLAIN [1
Firm E.D. NO. S.E.P.A. 11
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.
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
APPLI N ACC E2T Y PLANS CHECK,0 APPROVED FOR ISSUANCE
Owner Date. J - L BY
PLAN CH CK VALIDATION CK. M.O. CASH PERMIT VALIDATION --K. i M.O. CASH