HomeMy WebLinkAboutBLD9828 ReRoof Garage - BLD Application - 7/28/1976 z7d021d7e
4 RUIWING PERMIT APPLICATION -
MASON COUNTY IZ3?010 IIKT
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED
PERMIT NO. ��� 0
OWNER NAME MAIL ADDR SS CITY&STATE ZIP PHONE
.
ri I.Z4_Ali VAI-�,-1�� C -s aa�
DIRECTIONS
TO JOB SITE
LEGAL IF, SEE ATTACHED SHEET)
DESCR. 7' qcq 14 04 cot/ 11 Lof _NF 1,� /V 1 1-� x 130 13 -.2-
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADJITNON ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
Describe ork:
Valuation of work: $ Lyo PLAN CHECK FEE PERMIT FEE D_
SPECIAL CONDITIONS: �+
APP�N CCEPTED BY1 PLANS CHECK BY APPRO'ED FOR ISSUANCE Type of Occupancy Division
B 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 I am av,are of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work clone 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
�y SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Ownl& _ Date. �d WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH