HomeMy WebLinkAboutBLD9654 Fence - BLD Application - 6/30/1976r
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
/ Q/ DATE ISSUED Z
PERMIT NO. � T
OWNER NAME a MAIL ADDRESS / LMVI" �
E ��� ��` PWONE
�OS
l�a�c es � ox 30`7 gees 6
DIRECTIONS /11
TO JOB SITE 3D? le s-74 /� e An Khaex Vdrij
LEGAL q r 11 ! 1 (❑ SEE ATTACHED SHEET)
DESCR. 7r a G ! ! 07 1! J�C'�/-0 3t �S r�L C 3 7
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR elF
USE OF
BUILDING
Class of work: ❑ NEW )<ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: /
CX re n d f e n C(2 ct-r o u )t 6 a c uld r 1?'529 ire e74
10,
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
600' 00
SPECIAL CONDITIONS:
i
APPL ATIOQ ACCEPTED BY1 PLANS CHECK BY APPR VED FOR ISSUANCE Type of Occupancy Division
�6- B ff Const. 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 I
ordinance requirements regulating the work for which
*he permit is issued and all work done will be in Special Approvals Required Received Not Required
c,-nformance therewith. ZONING
HEALTH DEPT.
rm-- --- PUBLIC WORKS
ROAD DEPT.
ic. N': _ - ._ ._ _ Date
OWNERS AFFIDAVIT
.ertif at I am exempt from the requirements of the N O T I C E
contra--i or registration law RCW 18.27, and am aware
of ifi Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
wh-cv ;!;,.; permit is issued and that all work done will
n conformance(14erewlth. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
/`J\' IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owner .. [idle ro -30.. WORK IS COMMENCED.
-76
VALIDATION CP: M.O CASH PERMIT VALIDATION CK.d M.O. CASH