HomeMy WebLinkAboutBLD4754 Final SFR - BLD Permit / Conditions - 3/1/1978 ]i
A
L BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED �/�O /7 7
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESCR.I AIF XA1 S,= 11 7 —
CONTRACTOR
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
` .
ivo ►k` P I vim- - 2��m 4
USE OF
BUILDING Pe-Q idQ
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE/�O. yV
ql
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
BY Const. �� Group
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories f 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
o � HEALTH DEPT.
Firm A 111 Qt'4L t'UC� PUBLIC WORKS
By ROAD DEPT.
Lic. Nof"- Q- 1G-C:2&r1M d Dates 9-t?`�
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 SEPARATE PERMITS ARE of the Mason County ordinance requirements for VENTILATINGREQUIRED OR A R CONDTIONING FOR ELECTRICAL, PLUMBING, HEATING,
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.
7
N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
• Olason, Kenneth #4754
5-10-77
NE 1/4 SE 1/4 9-23-1
Plumbing Permit issued
Residence Mechanical Permit issued
$41,000.00
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