HomeMy WebLinkAboutBLD8560 Mobile Home - BLD Permit / Conditions - 10/3/1975 CokeP;?t, E. B. #8560
10-3-75
NWr, SW4s 28-23-1
Mobile Home
BUILDING PERMIT APPLICATION
MASON COUNTY
P. ®. Box 4W Shelton, Washinqton 98584
/D-3- 75—
r
DATE ISSUED _
PERMIT NO.
OWNER E MAIL ADDRESS ZiP PHONE?o 4oX/68. �e �f"g�lF.
DIRECTIONS TO 108 SITE �4 M r Le N, of 8 e L FA r,T-- j> C . In jj It-W A -
1E`WL MAIL AD DRESS ZIP —
�w�/ S , (OSEE ATTACKED !MEET)
DESCR. �� w /Y S e v Z 8 T P z 3 h2 !!�l _
► _
MAIL ADDRESS PHONE
CONTRACTOR
USE OF MAIL ADDRESS PHONE LICENSE NO.
BUILDING R C f4�—
Class of work: ❑NEW ❑ADDITION ❑ALTERATION ❑ REPAIR C91 OVE ❑ REMOVE
Describe work:
Nq -e, H e 1g63� / 07cS�' JVAS14 yor, M01)
e T K - 7 3 0 A-d t Vres s
Valuation of work:$ /2�"O PLAN CHECK FEE PERMIT FEE
2c� •oc,
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY
(J�_ Type �w Occupancy ,f
1 •L�L'��J� Const. i-[ � Group _1 Division
-- -- 7 Size of Bldg. No.of Max.
(Total)Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT Special Approvals Required Received Not Require
I Certify that I am a currently registered contractor in the State I INdi
of Washington and the County of Mason and I am aware of the HEALTH DEPT. s/
ordinance requirEments regulating the wcrk fcr which the permitWORKS
is issued and all work done wi,i be in conformance therewith. D DLPT.
Firm
By — —
Lic. No. Date
OWNERS AFFIDAVIT —
I certify that I am exempt from the requirements of the contract.
or registration law RCW 18.27, and am aware of the Mason
County ordinance requirements for which this permit is issued and that all work done will be in conformance therewith. N 0 T I C E
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING,
I y HEATING. VENTILATING OR AIR CONDITIONING.
Owner lG?« t Date �O V -3 " ! THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC-
TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF
120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
SH ELTON PRINTING CO.