HomeMy WebLinkAboutBLD N/A Moved in House - BLD Application - 2/23/1979 - . BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATEISSUED
/Z'3'2? 1C1 C��`Ilc�� PERMIT NO.
OWNER MAIL A DRESS _ CITY ATE ZIP PHONE
UIL41. c 'J 1 .3 ^
DIRECT S
TO JO SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. A � —of �7i /V g�e�3— /
CONTRACTOR NAME MAIL ADDRESS CITY&ATATE LICENSE NO. PHONE
rK
USE OF
BUILDING
1 tXL
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ RWAIR MOVE ❑ REMOVE
Describe work: _
n �
�O
/S *J-t
Valuation of work: $ ��" !76 PLAN CHECK FEE 7 v PERMIT FEE
0AIA
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT [-) NOTICE
BATHROOMS TOTAL SO. FT. GARAGE Ll
ATTACHED Ci SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT L1 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 [; FLOODPLAIN
Firm
E.D. NO. S.E.P.A. I 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.
which this permit is issued and that all work done will ROAD ACCESS
be in_.apnformance th ewith. MOTOR VEHICLE PERMIT
O?n Date.a�o.��'7 9 APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
123�' v����c>
S��ir e
Dennis A. and Jane B. MurphY
Star Rt. No.3, Box 35
belfair, Wa. 98528
fT
1 1.
I