HomeMy WebLinkAboutBLD5146 Mobile Home - BLD Permit / Conditions - 10/27/1976 Greenfield, Johnie #5146
` 10-27-76
Dayton Nimrod Hall
Tr. 8 NEµ NEµ 18-20-4
Mobile Home
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BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED
PERMIT NO.
NAME MA ADDRESS CITY&STATE // IP C� PHONE
OWNERddl S .CZ
DIRECTIONS
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESCR
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR Q
USF OF
BUILDING j'It
Class of work: EW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE f
C
SPECIAL CONDITIONS:
(CATION ACCEPTED BYJ PLANS CHECK BY APP CiVED FOR I SUANCE Type of Occupancy Division
J BY Z,� Const. j Group
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D. NUMBER
I Certify that I am a currently registered contractor in RESIDENCE
the State of Washington and I am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
HEALTH DEPT.
Firm PUBLIC WORKS
ROAD DEPT.
By
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
of the Mason County ordinance requirements for VENTILATING OR AIR CONDITIONING.
w ich this permit is i ued and that all work done will
In onform e t r with. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
6, SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owner atP� WORK IS COMMENCED.
PL CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH