HomeMy WebLinkAboutBLD9674 Mobile Home - BLD Permit / Conditions - 12/4/1979 Heitscuman; Mark #9674
12-4-79
17-23-1 Tr. 3 NE SE
1.4 miles south of Minimart
Mobile Home
► BUILDIN
G PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED /7
PERMIT NO. q(" 7-T
OWNER NAME IL ADDRESS CITY&STATE ZIP PHONE
DIRECTIA91
TO JOB SITE I L'ADWH
LEGAL (❑SEE ATTACHED SHEET)
DESCR.
CONTRACTOR
N ME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
_
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
A�L) eal-e-
In
Valuation of work: $ Q0 PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE [1
ATTACHED [i SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ 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 SHORELINES ❑
SEASONAL ( I FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. [I
By Special Approvals IN OUT
YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT
HEALTH DEPT.
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 BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is is ed and t t all work done will ROAD ACCESS
be in pfnfor nce th MOTOR VEHICLE PERMIT
Ow APPLICATION ACCEPTED BY PLANS CHECK A ROVE FQR ISS NCE
ne
ot
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K. M.O. CASH
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