HomeMy WebLinkAboutBLD4659 Move House - BLD Application - 4/22/1977 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED
PERMIT NO. �`5�
OWNER AME MAIL ADDRESS CITY&STATE ZIP PHONE
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DIRECTIONS __//
TO JOB SITE 771
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LEGAL (❑ E ATTACHED SHEET)
DESCR. Z3—� �Y'c c l� c 10GtJ S4— Y
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR }
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE KREMOVE
Describe work: ,
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Valuation of work: $ PLAN CHECK FEE ��--(;� PERMIT FEE
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
e r 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
^ r ( 1 HEALTH DEPT.
Firm---- �� G l ^` c:=�cs �c`4 PUBLIC WORKS
By ROAD DEPT.
Lic. No. �� 2.
Date
OWNERS AFFIDAVIT
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 SEPARATE PERMITS ARE REGUIRED FOR ELECTRICAL, PLUMBING, HEATING,
of the Mason County ordinance requirements for VENTILATING OR AR 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
Owner Date. WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH