HomeMy WebLinkAboutBLD3134 SFR - BLD Application - 9/28/1978 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 q/r2 ZAP
DATE ISSUED
PERMIT NO. ��J-' e"
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
'— 7-1
DIRECTIONS
TO JOB SITE F
LEGAL ( I n�'�A 0 P A C A L.l c`. 1 A b-), �i 0 V� r ti A `�j K.'[y - AD J 1^SEE ATTACHED SHEET)
NAME MAIL A DRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR —) La r��hl
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR MOVE ❑ REMOVE
Describe work:
Py
PERMIT FEE
PLAN CHECK FEE
Valuation of work: $ O"O
_ c• Q
SPECIAL CONDITION
BEDROOMS {DECKS CARPORT i. NOTICE
BATHROOMS I TOTAL SO. FT. GARAGE =:
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 AUTHORIZED
CONTRACTOR AFFIDAVIT 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
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 rzN, e c, 5� rl,. r r
E.D. NO. S.E.P.A.
By i ���c r Special Approvals IN OUT YES APPROVED NO
Lic. No.7_23 ��� l 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 ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
/- e
APPLICATION ACCEPTED BY PLANS CHECK BY A ROVED FOR ISSUANCE
J
O CASHr DatePLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK M.O.