HomeMy WebLinkAboutBLD7908 ReRoof - BLD Application - 12/8/1978 BUILDING PERMIT APPLICATION �-
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 p
DATE ISSUED
PERMIT NO. :P % Q d-
OWNER NAME ' MAIL ADDRESS CI &STATE ZIP PHONE
DIRECTIONS / 1
TO JOB SITE � e �.—
LEGAL [.,� "�` (❑ SEE ATTACHED SHEET)
DESCR. U 4 /
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING
aF---yam
Class of work: ❑ NEW ❑ A N ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ %� PLAN CHECK FEE PERMIT FEED 0-d
''4-�L d D
SPECIAL CONDITION :
BEDROOMS DECKS CARPORT Ll NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE L7
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT 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
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 Li SHORELINES
SEASONAL L1 FLOODPLAIN I i
Firm E.D. NO. S.E.P.A. 1
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
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work d ne will ROAD ACCESS
e i conformance therewith. MOTOR VEHICLE PERMIT
ICATION ACCE7TBY PLANS CHECK BY P VED FO SSUANCE
Owner11
PLA CHECK VALI ATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. ASH