HomeMy WebLinkAboutPartial Roof Removal - BLD Application - 12/23/1977 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
/ DATE ISSUED
!.� 6 PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
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LEGAL (❑ SEE ATTACHED SHEET)
DESCR. �.Z z 7/ Gu 7-
CONTRACTOR
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
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USE OF
BUILDING V C)
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION EPAIR ❑ MOVE ❑ REMOVE
Describe work:
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Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
BY Const. Group f�
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Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories 1 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
Firm PUBLIC WORKS
By
ROAD DEPT.
Lic. No. Date
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
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
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
Owner Date. �� 3,�� SUSPENDED WORK IS COMMENCED.
ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH