HomeMy WebLinkAboutBLD13127 Mobile Home #315 - BLD Application - 10/7/1982 I
BUILDING PERMIT APPLICATION
MASON COUNTY
61ej:T47��
P. . Box 186 Shelton, Washington 98584
426-5593 DATE ISSUED
PERMIT NO.
OWNER NAME MAIL DRESS CITY 8 STA E ZIP L PHONE
l�/D r � • S s S � d-o3 ,
DIRECTIONS �c
TO JOB SITE
LEGAL �^ (� SEE ATTACHED SH ET)
DESCR. /-,?0' t� .l�.3�6S/ ir, X.-) 07 SCU SLcJ
CONTRACTOR NAME MAIL ADDRESSj U ClYY 8 STATE LICENSE NO. PHONE
USE OF
BUILDING , Q
Class of work: jYNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR MOVE ❑ REMOVE
Describe work: A)
1y ' / 9
Valuation of work: $ �! w PLAN CHECK FEE PERMIT FEE y�
y Q `l� S
SPECIAL CONDITIONS:
BEDROOMS 3 DECKS CARPORT ❑ NOTICE
BATHROOMS_ cL TOTAL SQ. x 7� GARAGE
ATTACHED (= SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT [, OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE [1 DETACHED
Ej 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 IV SHORELINES
SEASONAL FLOODPLAIN I 1
Firm E.D. NO. S.E.P.A. f
By Special Approvals IN OUT YES APPROVED NO
Lie. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALT DEPT. 0- • CI-)-
RKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance the ewith. MOTOR VEHICLE PERMIT
Owner __ Date. /O qcP [CATION ACC A��j"Ilk
PT AY PLANS CHECK BY APPROVED FOR ISSUANCE
BY
PLV CHECK VALIDATION CK. M.O. CASH P MIT VALIDATION CK. M.O. CASH