HomeMy WebLinkAboutBLD4128 Final Sign - BLD Permit / Conditions - 10/12/1979 Century 21 Realty #4128
2-13-79
NW 1/4 SW 1/4 28-23-1 Lot A
Contractor
Sign City Sign
$2,000.00
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 /
DATEISSUED
PERMIT NO.
OWNER NA E MA I DRES &tSTES X ZIP — PHONE
2.vj
DIRECTIONS
TO JOB SITE •—
LEGAL. , (❑ SEE ATTACHED SHEET)
DESCR
CONTRACTOR
N ME PIL ADDRESS CITY&STATE LICENSE NO. �r�RH0�4Fy- Z e
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work6z
:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
ao.
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT "; ATTACHED C OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE I I DETACHED L
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT 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
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the FOR OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
C for an therewith PERMANENT [i SHORELINES 1 1
^ SEASONAL [ I FLOODPLAIN 11
Firm ` `�'` '
E.D. NO. S.E.P.A. i I
By Special Approvals IN OUT YES APPROVED NO
Lic. NoG�-s `�Z-'- rf Date ZONING
33¢0.8 PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
LIGATION ACCEPTED BY PLANS CHECK BY APPROVED F VSSI E
caner Date. BY y/
v
J CHECK VALIDATION CK. M.O. CASH - PERMIT VALIDATION CK. M.O. CASH
INVESTIGATION REPORT FORM
Revised 11/14/06
Case Number: N Cowl_ Parcel# R - 3a
Violation Site Address: 1,4 0'7 b r-n 401 2c rl P
Property Owner(s): DER j r C[j r fflQe, `AA CWAJ. LAC Telephone:
Mailing Address: 5 N�I V-.au.rnLL, Ind kafy a 141 991 q in
Occupant of Site or Operator:
Complainant Name: Telephone:
Complainant Address:
Location of Concern/Directions to Site:
Nature of Concern: > t U � S
Department of Concern: ❑Building ❑EH Septic ❑EH Solid 2Elanning ❑Fire ❑Public Works
�or Official Use Only Beyond This Point)
Received By:.� Date: q/to 1 -
7
Referred To: Date: �6
Investigation Date and Findings: -- p rbl,�\ &:b
c p
J.. 1
ck �
Resolution: w c o�l1�n 11 CI�VI�.� 4� CA
Name:
�. Dater(7.7 (d—_