HomeMy WebLinkAboutBLD9869 Mobile Home - BLD Application - 4/22/1982 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. �v Q
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
I VE , L110 0a ok Fir M 1 aj5_-37/6
DIRECTIONS (
TO JOB SITE Eajdof rG n 7 gt o rQ -� :-' fro,-, t�i 1't, I 1
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LEGAL ll (❑ SEE ATTACHED SHEET)
DESCR. d�,� y� SI J Y`I �� ��Qe . 7 T a3 tq ( o
CONTRACTOR NAME' MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: l9 NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
ay x
Describe work:
Valuation of work; � Q O PLAN CHECK FEE PERMIT FEE .
�✓. ✓
SPECIAL CONDITIONS:
BEDROOMS I DECKS _ CARPORT 11 NOTICE
BATHROOMS TOTAL SO. FT. GARAGE l i
NO. OF STORIES BASEMENT (._1ATTACHED I-I SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE 1; DETACHED L
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 FO 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 I 1
SEASONAL [ ; FLOODPLAIN (I
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
of the Mason County ordinance requirements for BUILDING DEPT. 2
which this permit is issued and that all work done will ROAD ACCESS
be iny conformance
(therewith. l MOTOR VEHICLE PERMIT
Owner �(�/ ` ( S Date �( j( �� APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
BY -�
PLV CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH