HomeMy WebLinkAboutBLD0218 Mobile Home - BLD Application - 9/18/1984 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 DATE ISSUED
PERMIT NO. C
OWNER NAME o JAIL DDRESS C TY&STATE ZIP PHONE
o 27 s'YF
DIRECTIONS qg 7
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. �07
NAME FAAII CITY&STATE LICENSE NO. PHONE
CONTRACTOR , O m / cA
USE OF
BUILDING es/�GoW rA
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERA ❑ REPAIR ElMOVf� REMOVE
Describe work:
Valuation of work: PLAN CHECK FEE PERMIT FEE
G,O ,q ��•oZ.f
SPECIAL/CONDITIONS:
BEDR MS I DECKS CARPORT ❑ NOTICE
B TH OOMS_ TOTAL SO. FT. GARAGE ❑
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
N STORIES/ BASEMENT ElATTACHED i] OR AIR CONDITIONING.
TOM SO. FT. B 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 FORA PERIOD OF 180 DAYS AT ANYTIME 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 �A'
Conformance therewith. PERMANENT I i SHORELINESYY
6a SEASONAL [ . FLOODPLAIN
Firm Q c J
(r' E.D. NO. S.E.P.A.
By J. Special Approvals IN OUT YES APPROVED NO
Lic. No. 4-110�&1o6 0n 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. 8'
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS QgBtl<BY JAPPROVED FOR I ANCE
Owner _ Date, BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH