HomeMy WebLinkAboutBLD12481 Roof Over Mobile Home and Porch - BLD Application - 5/27/1982 BUILDING PERMIT APPLICATION A M b6r[l
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 �
DATE ISSUED
PERMIT NO. f�41
NAJAE MAIL ADDRESS CITY&STATE ZIP PHQNE7S
OWNER
m bo IQ a77
DIRECTIONS oK 4N y 3 F,t'J, .. SL.c 6f' c -a#a •+ c,,� re
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DI JOB SITE i1/yli, Ab�� o? �'LocK-? -to e•i Lori �N /pc�C�h SI'l&jeit l�c� OwAwc'J sf..at` P.arek
LEGAL (❑ SEE ATTACHED SH ET) a /Uw tit Y
DESCR. a Pj_ cP '" 6 9#r ove#t-?
CONTRACTOR
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
�I
.S1✓h a
USE OF
BUILDING o h I e h u .-ki e Cv J e/
Class of work: ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:AGO andb )e oW► � v2c�
141
Valuation of work: $ ' PLAN CHECK FEE PERMIT FEEUd
SPECIAL CONDITION :
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SC FT. FIREPLACE ❑ DETACHED
Ll 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 ❑ SHORELINES nl&l
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. Ll
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
con ract or registration law RCW 18.27, and am aware BUILDING DEPT.
the Mason County ordinance requirements for .Z S 2
which this permit is i ed and that all work done will ROAD ACCESS
be forman t r MOTOR VEHICLE PERMIT
( �.� LIGATION C P ED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date e� BY�
P N CHECK VALIDATION CK. M.O. CASH P RMIT VALIDATION CK. M.O. CASH