HomeMy WebLinkAboutBLD8415 Pole Construction - BLD Application - 9/2/1975 BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584
DATE ISSUED Z, Z/7"5- _
E R M I T N 0.�5�A57-
OWNER MAIL ADDRESS ZIP PHONE --
DIRECTIONS-F —
TO JOB SITE
.LEGAL MA/I{LLADDREa�'�-- / :IP�7 --
DESCR. 4 { [�' � 1� �/'I � � {, � /�� K TACN Ep_S�[fl 4. / y
--� /--'�—%L_ G MAIL ADDRESS LLLIIJ l ////] RJl[/ (, /41, G
CONTRACTOR I / / zP
yUSE Of MAIL ADDRESS HON[
LICENSE NO.
BUILDING
Class of work: ba NEW ❑ADDITION n ALTERATION 0 REPAI R O MOVE ❑REMOVE
Describe work:
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b • �!
Valuation of work:$ U PLAN CHECK FEE c
�j = �— PERMIT FEE �u
SPECIAL CONDITIONS:
APPLIC TION ACCEPTED BY PLANS CHECKED BY APP VED FOR ISSUANCE BY
Type of Occupancy
..- t Const. Group Division
Q� maize of Bldg. No.of Max.
(Tot Sq.Ft. � Stories Occ.Load A),CONTRACTOR AFFIDAVIT
Special Approvals Required RecelVed Not Requi
I Certify that I am a currently registered contractor in the State XONINd
of Washington and the County of Mason and I am aware of the HEALTH DBPT,
ordinance requirements regulating the wcrk for which the permit F50 1110c W5AWg—
Is Issued and all work done wi;l be in conformance therewith.
Firm ,? - C '—
ray
Lic. No. g7o 7,V Date _7
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.
NOTICE
/ SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING,
HEATING. VENTILATING OR AIR CONDITIONING.
vner . F Date _7LS` 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.
'.AN CHECK VALIDATION CK M.O. CASH PERMIT VALIDATION CK. M.O. CASH
SHELTON PRINTING Co.