HomeMy WebLinkAboutBLD4036 Addition - BLD Permit / Conditions - 11/16/1976 1
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Bookout, John 0. #4036
11-16-76
W 545' NW4 NWT=, 17-20-4
Dayton Cut Off
Rt. 10 Box 468
Addition (Den)
$3,264.00
BUILDING PERMIT APPLICATION) .
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 /
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
fJ as
DIRECTIONS `
TO JOB SITE
LEGAL. , (❑ ATTACD SHEET)
DESCR 17—S�e—
CONTRACTOR N111 M ADDRESS CITY&STATE LICENSE NO. PHONE
7 r� 7D�j�
USE OF
BUILDING
Class of work: ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ >'�c / PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS: •J `o a
(CATION EPT D BY PLANS CHECK BY APPR�ED FOR IS�t1ANCE Type of Occupancy Division
B ;Q 2(t{.( Const. )/ Group
Size of Bldg. No. of Max.
(Total) Sq. Ft. /92 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
By
ROAD DEPT.
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
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
e in conformance t with. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
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
O e. Date. WORK IS COMMENCED.
PL N CHECK VALIDATION CK. M.O. CA
SH SH PERMIT VALIDATION VCK. M.O. CASH
L J