HomeMy WebLinkAboutBLD8520 Patio Cover - BLD Application - 9/24/1975 BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 58.84
DATE ISSUED ZZZXI-2,r _
PERMIT NO.
---� --_ MAIL ADDRESS �1/h h I01 i ZIP PHONE
OWNER I _ 3/2 4v_ly SA
DIRECTIONS� Sry�
TO JOB SITE 311 GU. f/ S¢. S osi
y
LEGAL I MAIL ADDRESS ZIP (❑5EE ATTACHED SNEET)
_y MAIL ADDRESS PHONE
—
CONTRACTOR , Q
USE OF MAIL ADDRESS PHONE LICENSE NO.
BUILDING
Class of work: ❑NEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑MOVE ❑ REMOVE
Describe work: 1 {
It, fe'vd LuaZz n'y ra 1, n"i fn)n Lwa—fhei,- ny3o lee !o;�
.4
Valuation of work: $ oU
/ / PLAN CHECK FEE PERMIT FEE o�
SPECIAL CONDITIONS: C
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY
Type of Occupancy
�— Const. Group J Division
-— -- — — Size of Bldg. No.of Max.
(Total)Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT Special Approvals Required Received Not Require
I Certify that I am a currently registered contractor in the State _NIN d _
of Washington and the County of Mason and I am aware cf the HEALTH DEPT.
ordinance rcquircments regulating the wcrk fcr which the permitWORKS
is issued and all work done wi;l be in conformance therewith. AMD DEPT.
Firm
By -
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the contract _
or registration law RCW 18.27, and am aware of the Mason
County ordinance requirements for which this permit is issued and that all work done will be in conformance therewith. N O T I C E
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING,
M� HEATING. VENTILATING OR AIR CONDITIONING.
Own /YLG� � � Date THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC-
TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF
120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
JPLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
SMELT ON PRINT,NO CO.