HomeMy WebLinkAboutBLD5651 Addition - BLD Application - 7/29/1977 BUILDING PERMIT APPLICATION
MASON COUNTY /Z320 /Z0 //20
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED�7/2 ZZ
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
rL '7v /3
DIRECTIONS ••
TO JOB SITE * O
LEGAL /_ (❑ SEE ATTACHEDzl�
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
f
Valuation of work: $ p/Al .-0 PLAN CHECK FEE PERMIT FEE n•
SPECIAL CONDITIONS: W '7
AP LICATION ACCEPTED BY PLANS CHECK BY APP ED FOR IS6UANCE Type of Occupancy Division
B Const. Group
/_
'L!l (JK"'
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
ybe * 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.
AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH