HomeMy WebLinkAboutBLD0020 Relocate Mobile Home - BLD Permit / Conditions - 5/3/1983 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 3 � "
DATE ISSUED ---
PERMIT NO. 0 -
CITY 6 STATE ZIP PHONE
NAME }� MA14 ADDRESS n _ ( -g - E'-
OWNER , ' �
DIRECTIONS / f
TO JOB SITE d
(U SEE ATTACHED SHEET)
LEGAL 3,� _ a 3
DESCR. 1.L .20 JAI'' LICENSE NO. PHONE
NAME MAIL ADDRESS CITY 8 STATE
CONTRACTOR
USE OF f
BUILDING S
Class of work: C NEW ❑ ADDITION r ALTERATION O REPAIR MOVE ❑ REMOVE
Describe Work: J �
X
PLAN CHECK FEE PERMIT FEE y (
Valuation of work: $ /, /
SPECIAL CONDITIONS: Y
BEDROOMS. _._♦_♦._—^ }DECKS____ .-- -- CARPORT .
NOTICE
BATHROOMS-!.—— I TOTAL SQ. FT. GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
ATTACHED - OR AIR CONDITIONING.
NO. OF STORIES-- BASEMENT DETACHED
TOTAL SO. FT. �V FIREPLACE THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
WORK IS COMMENCED.
i certify that 1 am a currently registered contractor in FOR OFF ICE USE ONLY
the State of Washington and I am aware of the
ordinance requirements regulating the work for which
the permit is issued and all work done will be in PERMANENT ✓ SHORELINES A 6L,
conformance therewith. SEASONAL FLOODPLAIN
S.E.P.A. ;
Firm E.D. NO— _ -- IN OUT YES APPROVED NO
Special Approvals
By
ZONING
Lic. No. — Date
PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVITPUBLIC WORKS "
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for ROAD ACCESS
which this permit is issued and that all work done will
7ncformance therewith. MOTOR VEHICLE PERMIT PLANS K BY P PROT FOWUAN
APPLICATION ACCEPTED By y j'r l
Owner Date '
CASH
PERMIT VALIDATION CK M.O.
P AN HECK VALIDATION CK. M.O. CASH �./