HomeMy WebLinkAboutBLD17624 Change in Use- Living Room to Bedroom - BLD Application - 7/8/1985 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. f /
NAME MAIL ADDRESS CITY 6 STATE ZIP PHONE
OWNER
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DIRECTIONS O JOB S T E N w ( o
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. /
CONTRACTOR NAME4 MAIL ADDRES9 CITY&STATE LICENSE NO. PHONE
USE OF LL
BUILDING A 6to r e W +tFl G a Sec- roc r, QP+ 1 n hQsK
Class of work: ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
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Valuation of work: $ PLAN CHECK FEE PERMIT FEE4000
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SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS__ TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. I FIREPLACE ❑ DETACHED ❑
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 F0�0 F F I C E USE ONLY
or finance requirements regulating the work for which
th permit is issued and all work done will be in
c0 formance therewith. PERMANENT SHORELINES
SEASONAL ❑ FLOODPLAIN
Firm
E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT. �• Y/YIs
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 conf anc�wit . MOTOR VEHICLE PERMIT
Owner —� �+ Da _O O APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
BY
1 0 PLAN CHECK VALIDATION CK.. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
CHRISTMASTOWN PRINTING
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