HomeMy WebLinkAboutBLD9778 Shingle Roof - BLD Application - 7/22/1976 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED,
PERMIT NO.
OWNER N MAID A DRIESS GTY 6 STATE ZIP PHONE
DIRECTIONS
TO JOB SITE -e,- 't
LEGAL D / � (0 SEE ATTACHED SHEET)
DESCR. 7A)- SO ,
NAME MAIL ADDRESS GTY 3 STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING AA -xyC
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ /Q PLAN CHECK FEE PERMg EE
Oq
SJ_ t cl
SPECIAL CONDITIONS:
PPLICATION ACCEPTED BY1 PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
Const. Group
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I certify that I am a currently registered contractor in RESIDENCE
the State of Washington and 1 am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
HEALTH DEPT.
Firm PUBLIC WORKS
By ROAD DEPT.
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware
of the Mason County Ordinance requirements for SEPARATE PERMITS ARE REQUIREDFOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be in:74-
anc@/terewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
.. eIS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
/ SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owner Date. 7� y ` WORK IS COMMENCED.
N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
I