HomeMy WebLinkAboutBLD Carport #72 - BLD Application - 12/22/1982 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 g
DATE ISSUED
PERMIT NO.
OWNER NAME / MAIL ADDRESS CITY&STATE 21P PHONE
bsa JP. w��/e - /7i 2 sal e,llo .5 , o !� $5
DIRECTIONS
TO JOB SITE /�j � yjf 4,-�O//
LEGAL (� (❑ SEE ATTACHED SHEET)
DESCR. �R —� _ J r�� �S'.�i
CONTRACTOR
NAME MAIL ADDRESS (• �CITY 8 STATE LICENSE NO. PHONE
9&4 4//i /7e �17 ��[[eI e/l, /fI _S/e o
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
av ` U/s�
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT D NOTICE
BATHROOMS TOTAL SO. FT. GARAGE fJ
ATTACHED I� SEPARATE PERMITS ARE REOUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE DETACHED L
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 OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME 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 I
SEASONAL Ll FLOODPLAIN L 1
Firm
E.D. NO. S.E.P.A. II
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conforrDa e therewi Q MOTOR VEHICLE PERMIT
Owner 4:: 44yr 4 Date _ _ v APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
10014-- ---------
PL CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
v
�aooi . 33 - 0006 0
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