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HomeMy WebLinkAboutBLD4802 Cement Floor - BLD Application - 8/25/1976 BUILDING PERMIT APPLICATION + MASON COUNTY P.O. Box 186 Shelton, Washington 98584 DATE ISSUED s 7 lPERMIT NO. Wet1;), NAME U, MAIL ADDRES �— -- CITY&STATE ZIP PHONE OWNER ©. ,� S't,�7 JC�K 7Os rem �271�/U Ctlr�. �� - 2W DIRECTIONS TO JOB SITEFH LEGAL / (G SEE ATTACHED SHEET) NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE CONTRACTOR USE OF BUILDING 6-q e,46-(s Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: ti — /c/� r Valuation of work: $ 0� ae PLAN CHECK FEE PERMIT FEE , SPECIAL CONDITIONS: APPLICATION CC ED BY, PLANS CHECK BY A"ROVED FOR ISSUANCE Type of Occupancy Division Const. Group 'Z4 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 REQUIREDFOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. which this permit is issued and that all work done will be in gonformance there Ith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS j SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER owner•_, 1� Date. c/3� 7 WORK IS COMMENCED. PLA CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K.J M.O. CASH