HomeMy WebLinkAboutBLD14682 Roof Extention - BLD Application - 9/16/1983 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 1 U� —
' DATE ISSUED r�
PERMIT NO. ( ` `��'
NA i MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER /� � e' �i71
DIRECTIONS C• GIV.
TO JOB SITE
LEGAL I E ATTAC � ADESCR. - / .. �/ f
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING isljtl
Class of work: ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
lam'
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ';
NO. OF STORIES BASEMENT C]
ATTACHED I 1 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE i ; DETACHED I'
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME 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 U E ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELIN
SEASONAL LI FLOODPLAIN
Firm E.D. NO. S.E.P.A.
By Special Approvals IN OUT YES APPROVED NO
Lic. No.— Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I cert' y that I am exempt from the requirements of the FIRE MARSHAL
con act or registration law RCW 18.27, and am aware
of BUILDING DEPT.
the Mason County ordinance requirements for
w ich this permit is issued and that all work done will ROAD ACCESS
e in confor ante th rewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
;7)
Oe`hler l Dategv
.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
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