HomeMy WebLinkAboutBLD79-4059 - BLD Permit / Conditions - 1/24/1979 BUILDING PERMIT APPLICATION ,
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 g
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&ST TE ZIP PHONE
DIRECTIONS
TO JOB SITE h ( c. !4-
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. ' / 1114r �G �d 1 ,LE•
NAMIt MAIL ADDRESS CITY&S TE LICENSE N PHONE
CONTRACTOR r — n
USE OF
BUILDING ,,f
Class of work: ❑ NEW ❑ ADDITION 7 ALTERATION 50 REPAIR El 4 VE ❑ REMOVE
Describe work:
rf
Q J rZL• A b t 7 `k r '!vG GC `Y -� L
Valuation of work: $ PLAN CHECK FEE PERMIT FEE , G�
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED AIR CONDII ONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED
Ll THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT IS NOT COMM NCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OF 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 ❑ SHORELINES ❑
SEASONAL ❑ FLOODPLAIN ❑
fi �.0 c.
Firm � �"� �� � E.D. NO. S.E.P.A. ❑
By „C /,-- (� 1 ` Special Approvals IN OUT YES APPROVED NO
Lic. No.U �(���` 1c1' —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 /� �Tsh 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 VEHICL= PERMIT
AP TION ACC TED Y PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date. BY
- jr-
PLAN CH CK VALIDATION CK. M.O. CASH PERMIT VALIDATION tqC M.O. CASH