HomeMy WebLinkAboutBLD6435 Pole Construction - BLD Application - 5/20/1980 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. ���_�
MAIL D RE TY 8 T TE ZIP r PNL�
OWNER VhO
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DIRECTIONS
TO JOB SITE
LEGAL I (❑ SEE ATTACHED SHEET)
DESCR. id JUI((J fyj, }1 /z 3 /V ,
CONTRACTOR NAM 01AIL ADItESS CITY 6 STATE I-ItENSE NO. PHONE
USE OF
BUILDING
Class of work: EW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
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Valuation of work: $ / f PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS: J
BEDROOMS DECKS CARPORT LI NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE []
ATTACHED LI SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT [_I OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE DETACHED
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
conformance therewith. PERMANENT I I SHORELINES
SEASONAL I I FLOODPLAIN 1
Firm
E.D. NO. S.E.P.A. ! 1
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
I in conformance therewith. MCAOR VEHICLE PERMIT
ATION A
9Cft5W'BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date. J K BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION('--c")
M.O. CASH
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