HomeMy WebLinkAboutBLD9918 Carport - BLD Application - 8/10/1976 'j. /' . ,yoI-Fm &- n
BUILDING PERMIT APPLICATION '5�6 7e�
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
OWNER n rii 1 t'` - Sr its k 7J 3/
DIRECTIONS
TO JOB SITE
LEGAL l (❑ SEE ATTACHED SHEET)
DESCR. ��rQ'
NAME MAIL ADDRESS GTY 8 STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
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Describe work:
Valuation of work: $ d[�(t PLAN CHECK FEE PERMIT FEE
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SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY! PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
BY 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
HEALTH DEPT.
Firm PUBLIC WORKS
By ROAD DEPT.
Lic. No. 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
of the Mason County ordinance requirements for VENTIILAT NG OR A R CONDITIONING.
FOR ELECTRICAL, PLUMBING, HEATING,
ONING
which this permit is issued and that all work done will
/ be in conformance there 'th. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
L'/7'� 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. r� WORK IS COMMENCED.
P CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH