HomeMy WebLinkAboutBLD18516 Remodel - BLD Application - 4/14/1986 PLEASE COMPLETE APPLICATION, SIGN, AND RETURN WITH CHECK IN THE AMOUNT OF $34.00
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 _ L/
DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS / CITY&STATE 1 ZIP PHONE
OWNER 632
- _Z 05
DIRECTIONS
TO JOB SITE E SAS I
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. William J. Murphy's Brookpoint Tracts Tract 15 Por G.L. 2 35-22-3
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING Complete Remodel
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
I
Describe work:
57/
Valuation of work: $ PLAN CHECK FEE PERMIT FEE 5 Q
0 oo �O /V_ 3 a7.
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS 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 AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 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
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 certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
which this ermit is issued and that all work done will ROAD ACCESS
be in cc or nce therewith. / MOTOR VEHICLE PERMIT
Owner Date. L Y� APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
V�
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
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