HomeMy WebLinkAboutBLD4399 ReRoof - BLD Application - 3/3/1977 1
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 9858 7
n DATE ISSUED /3/77
- -�`- ✓� 0'eL*1 `3/ to e0PETiMITNO.
OWN NAME MAIL ADDRESS CITY&&rATE ZIP PHONE q
-S CJ
DIRECTIONS
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESCR.
CONTRACTOR
NAME /7 MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING �-y Z t LE 01 c-
Class of work: ❑ NEW ❑ iJ DITION ❑ ALTERATION ly REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE A-0
SPECIAL CONDITIONS: '
APPLICATION ACCEPTED BY PLANS CHECK BY ROVED FOR IS DANCE Type of Occupancy Division
Const. Group
01(,LI-e
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 I 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 REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be In conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS 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. WORK IS COMMENCED.
i
P AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH