HomeMy WebLinkAboutBLD17677 Divide One Room into Two - BLD Application - 7/19/1985 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 �J Q/�
DATE ISSUED / '1 9-"`5
MIT NO. ! 76 7 7
OWNER NAME MAIL ADDRESS CITY 6 STATE ZIP PHONE
Public Hospital District #1 Mason County W Shelton 98584 426-1 11
DIRECTIONS
TO JOB SITE Eelfair Center, Eelfair Wa. North Mason Medical Clinical
LEGAL Tract 5 NWk of SWk District code 276 Tray 61 Pg 880 (❑ SEE ATTACHED SHEET)
DESCR. o�g-oZ 3'f
CONTRACTOR NAM MAIL ADDRESS CITYcontractelA STATE C E — R
Eeb Fuller Shelton 426-6449
USE OF r IlLectric—illetfair DELFAOEC 191LA 876-3652
BUILDING Medical treatment
Class of work: ❑ NEW ❑ ADDITION k ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: ��
divide 1 room into 2 reems(partition -partition off a Patient waiting
addition of 2 doors(interion-aditton of an outdoor door entrance -add a
n exit emerspney door
Addition of %-Raymachine
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
c,P
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SPECIAL CONDITIONS:
BEDROOMS DECKS YesCARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. F7.1900 GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 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 lJ SHORELINES ❑
SEASONAL L; FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT. '$8S 7-$-95 k--
OWNERS AFFIDAVIT HEALTH DEPT. z
PUBLIC WORKS
1 certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT. /(� r�
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
e in co forma ce the ewith. MOTOR VEHICLE PERMIT
0 ° 7 -�._ �J APRIICATION ACCEPTED BY PLANS CHE K BY AP ROVED FOR ISSUANCE
Owner Date Y
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK M.O. CASH
CHRISTMASTOWN PRINTING
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PORT ORCHARD, WA 98.M
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