HomeMy WebLinkAboutBLD4176 Fence - BLD Application - 1/5/1977 BUILDING PERMIT APPLICATION
MASON COUNTY Llao►a •ss _ 0000!S
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED 7 S'
PERMIT NO.
OWNER NAM MA�ADDRESS CITYlB STATE ZIP PHONE
DIRECTIONS J
TO JOB SITE y � /� .v o c7U ,
LEGAL // (❑ SEE ATTACHED SHEET)
DESCR. c `jay L
r NAM MAIL A DRE S CITY&STATE LICENSE NO. PHONE
CONTRACTOR
N
USE OF
BUILDING (9 Yi
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe wo
e e
Valuation of work: $ A;rj ® PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
AP ICATION ACCEPT D BY PLANS CHECK BY ROVED FOR I SUANCE Type of Occupancy Division
lityl (� Const. Group
Size of Bldg. No. of Max.
(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.
Firm PUBLIC WORKS
ROAD DEPT.
By
Lic. No. Date
OWNERS AFFIDAVIT
I certify that 1 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 con f rice there 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 ate. WORK IS COMMENCED.
CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. ASH J