HomeMy WebLinkAboutBLD9292 Insulation and Roofing - BLD Application - 5/10/1976 -� BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STA TE ZIP PHONE
DIRECTIONS
TO JOB SITE C-0 5 1/(Cj S�q (Uz! 6(&AZ
LEGAL 'T (❑ SEE ATTACHED SHEET)
DESCR. AS 5 0 K 6_ COdZ/)r_2 sf-`l -L LL)
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
6 F_ vnF;�9 ' c o 'Odd 4 � ,F 2' � � �
USE OF
BUILDING 5F kl✓iC'r 5 i* (O�tl 0 Cep Y4rU4 !?6 1 jeoOM 119AX— fS
Class of work: [ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
i r
�4�F • 6
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
-SPECIAL CONDITIONS: ' - ,OO
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR.ISSUANCE Type of Occupancy Division
Const. Group
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I certify that I am a currently registered contractor in RESIDENCE
the State of Washington and I am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
n HEALTH DEPT.
Firm ���✓�GuZ 1�<n`v1� KC,c7�y�t1�G Cp PUBLIC WORKS
By. r/YYL6i�J X l 1�/�Ll(/- ROAD DEPT.
Lic. No. Z 43 OZ%OcS'S�l Date 7
OWNERS AFFIDAVIT
1 I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIREDFOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be in conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
\ 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
qer Date. WORK IS COMMENCED.
HECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH