HomeMy WebLinkAboutBLD7784 Siding - BLD Application - 10/31/1977 410111'"W
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED 77
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OWNER F/ 1% /0 MAIL ADDRESS CITY 8 STATE ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL ;> (❑ SEE ATTACHED SHEET)
DESCR. rnJ�C ;f ' 5�
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
ScL/Z
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
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Valuation of work: $ �C'G� l PLAN CHECK FEE PERMIT F
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 l 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 SEPARATE PERMITS ARE REQUIRED of the Mason County ordinance requirements for VENTILATING OR AIR CONDITIONING.
FOR ELECTRICAL, PLUMBING, HEATING,
which this permit is issued and that all work done will
be In conformance therewith. �y '7 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
/Wnr .Uate J WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH