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HomeMy WebLinkAboutBLD8714 Mobile Home - BLD Application - 12/9/1975 BUILDING PERMIT APPLICATION MASON COUNTY P. O. Box 4W Shelton, Washinqton 98584 DATE ISSUED �J PERMIT NO. 1,Z7 PHONE j OWNER;�Geyfe� ' ad Lit, G1'`V y, 1' �jf31G� - — DIRECTIONS r� TO JOB SITE L®� >� 6�4d�S c�/•�_ z'6(/e ,o _ z' S 410 t.M AL MAIL ADDRJ[y9t ZIP CJSEE ATTACHED SHEET) DESCR.� -. _y MAIL ADDRESS PHONE CONTRACTOR I USE OF MAIL ADDRESS PHONE LICENSE NO. BUILDING Class of work: ❑NEW ❑ADDITION D ALTERATION ❑ REPAIR ❑MOVE O REMOVE a Describe work: Valuation of work:$ 1/ ["©p PLAN CHECK FEE PERMIT FEE SPECIAL CONDITIONS: /•7 �(/ APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Type of Occupancy Const. Group Division Size of Bldg. No.of Max. (Total)Sq. Ft. Stories Occ.Load CONTRACTOR AFFIDAVIT Special Approvals Required Received Not Required I Certify that I am a currently registered contractor in the State ZONINO of Washington and the County of Mason and I am aware of the HEALYH DEPT. ordinance requirements regulating the work for which the permit PUSILIC wonRe Is Issued and all work done wi:i be in conformance therewith. 1145A5 DEPT. Firm By Lic. No. Date OWNERS AFFIDAVIT I certify that I am exempt from the requirements of the contract or registration law RCW 18.27, and am aware of the Mason N 0 T I C E County ordinance requirements for which this permit is issued and that all work done will be in conformance therewith. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING. VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC- TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF owner. Date �'/7r,. (r 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION (CK)I M.O. CASH SHELTON PRINTING CO.