HomeMy WebLinkAboutBLD80-7687 - BLD Application - 10/17/1980 r BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, WashinOton 98584
426-5593
DATEISSUED G
PERMIT NO.
OWNER NAME Y MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS 7c! �i {k f Cii�crl) � < `- '��alLT� ! "C:' i llCttet',
TO JOB SITE .�iai7� 3-10A) .— 1-7-f>0t) 46cJ_, c'AJ
LEGAL rr _ (❑ SEE ATTACHED SHEET)
DESCR. L �I T/ ��J(-`.�G dd!774741 S
NAME AJC+ MIJMAIL ADDRESS CITY&S1 ATE LICENSE NO. PHONE
CONTRACTOR _ '
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION XALTERATION ❑ REPAIR ❑ NI VE ❑ REMOVE
Describe work:
Valuation of work: $ r PLAN CHECK FEE PERMIT FEE "Q
SPECIAL CONDITIONS: J
BEDROOMS {DECKS CARPORT ❑ NOTICE
BATHROOMS (TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING..
TOTAL SQ. 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 ORIIABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME 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 ❑
lG�f/ r SEASONAL ❑ FLOODPLAIN El
FirmLj� C- E.D. NO. S.E.P.A. ❑
By 1 #-" - `✓ a=� -r , Special Approvals IN OUT YES APPROVED NO
Lic. o, f �A Date / ZONING
I
CANNING DTP
O ERS AFFIDA
MV HEALTH DEPT.
6 - Ae� 31) � PUBLIC WORKS
I certify that I am a empt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aw --�
aret / 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. TOR VET ERMIT
P LICATION AC E ED BY PLANS CHECK BY A ROV R ISS E
Owner _ Date , .� BY
'LAN CHECK VALIDATION CK. M.O. CASH 'PERMIT VALID 10 CK. M.O. CASH