HomeMy WebLinkAboutBLD4795 Barn - BLD Application - 11/21/1977 4
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED ///Z 1/-7 7
PERMIT NO. 7O 7 7
OWNER NAME _ MAIL ADDRES CITY&STATE ZIP PHONE
ulay RAE M CAIM LIA - cW16 27s
DIRECTIONS /;
TO JOB SITE /2 FROr') BO-F IR aN Gt 'Bf1-F*k #WAY OFF MCV �1 1*4ffS 0, 4FT &dam
LEGAL SE se, ^� (❑ SEE ATTACHED SHEET)
DESCR. S L-r-noN 2 b " wilii p G N$ W,/ 1 ,
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR O WC R
USE OF
BUILDING O t10USh tiaRSES
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
16 x 20 s nit BORN FLOci2 Room
1 �
a
Valuation of work: $ 2500 c PLAN CHECK FEE PERMIT FEE �L� �
SPECIAL CONDITIONS: 7�
$4ON
APPLICATION ACCEPTED BY PLANS CHECK BY APPR ED FOR ISSUANCE Type of Occupancy Division
BY 0_ _t- Const. Group
`S 4- vl
Size(Total) gldg No.Ft. 1bX20 Stones 1 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 conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
o IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
I> SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owner Date / <r�1 WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH