HomeMy WebLinkAboutBLD75-8688 - BLD Permit / Conditions - 11/28/1975 BUILDING PERMIT APPLICATION
MASON COUNTY
P. 0. Box 400 Shelton, Washinqton 98584 f l
(wry (';DATE ISSUED
PERMIT NO.
OWNER �--7— �- MAIL ADDRESS —�-- ZIP PHONE
AAAI
DIRECTIONS
TO 10B SITE
MAIL ADDRESS Zip —
LEGAL �7�-- t J (OSEE ATTACHED SHEET)
DESCR. ,L 0 / p� 6_— jP� IO 0 CY
MAIL ADDRESS PHONE
CONTRACTOR (�e
USE OF J MAIL ADDRESS PHONE LICENSE NO.
BUILDING
Class of work: 0 NEW ❑ADDITION krALTERATION 'Cl REPAIR ❑MOVE O REMOVE
Describe work:
Oov 'Oeo Q i�*l
Valuation of work:$ PLAN CHECK FEE PERMIT FEE
�®0, O
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECKED BY A O FOR ISSUANCE BY
Type of Occupancy
„a Const. Group Division
Size of Bldg. No.of Max.
(Total)Sq. Ft. Stories Occ.Load
CONTRACTOR AFFIDAVIT Special Approvals Required Received Not Require
I Certify that I am a currently registered contractor in the State 'ZONING
of Washington and the County of Mason and I am aware of the HEALTH DEPT.
ordinance requirements regulating the work fcr which the permit F50110C WORRe
Is Issued and all work done will be in conformance therewith. ROAD DEF27,
Firm
By -
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the contract
or registration law RCW 18.27, and am aware of the Mason N O T I C E
County ordinance requirements for which this permit is issued
and that all work done will be in conformance therewith. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING,
HEATING. VENTILATING OR AIR CONDITIONING.
f+ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
( AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC-
TION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF
ow4erDnk �-- Date j/ .�` 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION M.O. CASH
51FIE1-TON PRINTING CO.