HomeMy WebLinkAboutBLD76-5034 - BLD Permit / Conditions - 10/1/1976 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
r1 Ll DATE ISSUED
PERMIT NO. �Q 41
OWNER AME MAIL ADDRESS CITY&STAT ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL _ (❑ SEE ATTACHED SHEET)
DESCR. Jr r
NAME MAIL ADDRESS �' CI STATE `LICENSE NO. PHONE
CONTRACTOR . _(f�G�''
f
USE OF I h4—C W—X IG 112-�26 '/-1 H
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION JFREPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ x PLAN CHECK FEE PERMIT FEE ,(f �
SPECIAL CONDITIONS:
AP LICATION EP ED BY PLANS CHECK BY ROVED FOR ISSUANCE Type of Occupancy j� Division
/7 R
Const Group /
i"L��
a61U� �t'l LL
Size of Bldg.-- No. of Max.
�G (Total) Sq. 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,
P C: . PUBLIC WORKS
Firm �L-r--� a
By ROAD DEPT.
Lic. No. Date Z7 -Z
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 SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
of the Mason County ordinance requirements for VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be In conformance 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
Owner Date. WORK IS COMMENCED.
QICHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K. M.O. CASH