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HomeMy WebLinkAboutBLD10042 Post and Sign Install - BLD Application - 2/10/1981 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 DATEISSUED PERMIT NO. OWNER NAME AIL ADDRESS CITY& ATE ZIP PHONE ltwk DIRECTIONS TO JOB SITE LEGAL (❑ SEE ATTACHED SHEET) DESCR. NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE CONTRACTOR C34 z4/0� USE OF BUILDING Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: Valuation of work: $ PLAN CHECK FEE PERMIT FE C, ' ,.© 42, SPECIAL CONDITIONS: BEDROOMS I DECKS CARPORT ❑ NOTICE BATHROOMS TOTAL SQ. FT. GARAGE U ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES BASEMENT [.] OR AIR CONDITIONING. TOTAL SO. FT. 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 FORA PERIOD OF 180 DAYS AT ANYTIME 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 [-, 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. 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 RO ACCESS be in conformance th with. MO R VEHICLE PE MIT ^ ���-_ si ! A ATION ACC E BY PLANS CHECK BY APPROVED FOR ISSUANCE Owne � � Date. / BY PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M. . CASH