HomeMy WebLinkAboutBLD15395 Mobile Home #416 - BLD Application - 4/17/1984 WING PERMIT APPLICATION
olcl sioW-a- aa, MASON COUNTY
EU3 �5+1.Ce �} (� P.O. Box 186 Shelton, Washington 98584
426-5593 DATE ISSUED
PERMIT NO.
OWNER M MAIL ADD RE CI STA ZIP PHONE
1�e le
DIRECTIONS
JOB SrITE J uG0" riGe'► /—GO a; l� �S744S zv� vZ 12
LEGAL c� 1l,, / / SEE ATTACHED S�H�T)
DESCR. L [ S� ��►�'1,V- oOV w 8X�,3 t.9e ,Ate.
CONTRACTOR NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. W P ONE
USE OF
BUILDING to 0-4 e— Y`L4'r�ebGe n --
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe r /C �C,
:,aX el& L
Valuation of work: $ PLAN CHECK FEE PERMIT FEE ot%
SP CIAL CONDITIONS:
BEDROOMS ;L I DECKS >ATTACH
Cj NOTICE
BATHROOMS_ - TOTAL SO. FT. SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING. VENTILATING
NO. OF STORIES BASEMENTOR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE IJ
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
SEASONAL I FLOODPLAIN ! !
Firm E.D. NO. S.E.P.A. [I
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
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 therewith. MOTOR VEHICLE PERMIT
AROLIC,T ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner/�cL Date . �J BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH