HomeMy WebLinkAboutBLD8474 Carport - BLD Application - 9/12/1975 BUILDING PERMIT APPLICATION
MASON COUNTY �ZZ3q Cf 3 000
P. O. Box 400 Shelton, Washinqton 98584
DATE ISSUED _
PERMIT NO. � �7
-�- _—�— ---- - MAIL ADDRESS----_----- ---ZIP PHONE -- �-
OWNERi
DIRECTIONS
TO JOB SITE I
LEGAL MAIL ADDRESS ZIP C]aEE ATTACHED SHEET)
— �— MAIL ADDRESS L PHONE
CONTRACTOR
USE OF MAIL ADDRESS PHONE LICENSE NO.
BUILDING Z
Class of work: ,NEW ❑ADDITION El ALTERATION ❑ REPAIR ❑MOVE ❑REMOVE
Describe work:
Valuation of work:$ ` d C
PLAN CHECK FEE PERMIT FEE /
F SPECIAL CONDITIONS:
APPLICATION ACCEPTED By PLANS CHECKED BY APPROVED FOq ISSUANCE BY
Type of — Occupancy
Const. Group 1 Division
-•Xsd LAC 7/�'
---- Size of Bldg. No.of Max.
(Total)Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT Special Approvals Required Received Not Require
I Certify that I am a currently registered contractor in the State f INd
of Washington and the County of Mason and I am aware cf the HEALTH DEPT.
ordinance requirEments regulating the wcrk fcr which the permitWORKS
is issued and all work done wi:l be in conformance therewith. P41=5 DgpT,
Firm
By -
Lic. No. Date
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
Counly ordinance requirements for which this permit is issued and that all work done will he in conformance therewith. N 0 T I C E
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING,
Q �7 HEATING. VENTILATING OR AIR CONDITIONING.
Owner ��'?/ �•c- gte /—�� /� 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.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
t// SM ELTON PRINTING CO.