HomeMy WebLinkAboutBLD7676 House to be Moved - BLD Application - 7/2/1976 1
BUILDI PERMIT APPLICATION * '
MASON COUNTY
P.O. Sax 186 Shelton, Washington 98584
DATE ISSUED 7-0? --76
PERMIT NO. - 76
OWNER NAME MAIL ADDRESS CITY"TATE ZIP PHONE
DIRECTIONS
TO JOB SITE ` �ry��\Q �t�. 'S►CX� A.�}gi I n I^ �1 c�IJC
LEGAL (I] EE ATTAC ED SHEET)
DESCR.
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
6t � �s - I�yol, l��"�l,e .S. r }I'P wit <lyz�
USE OF
BUILDING Tj V 1� ����
iyl _
Class of work: ❑ NEW ❑ ADDITION _l ALTERATION ❑ REPAIR jiV&VE E—j REMOVE
Describe work: II
U r vioo"A I o Quo Qe `: r Ck , d %AA 6aU)'vim
v v
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY, PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
�t Const. Group
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 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� .AC=N-y`.0. �'rn-�w'�C>�. Date ( ✓�I� WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK, M.O. CASH
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