HomeMy WebLinkAboutBLD16179 Change of Use Pre-Inspection - BLD Application - 9/27/1984 BUILDING PERMIT APPLICATION
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WA. CIS``0`11"_ MASON COUNTY
141 a P.O. Box 186 Shelton, Washington 98584
14 +G 426-5593 _ —
DATE ISSUED �
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COT ��
/ as e, PERMIT NO.
OWNER NAM MAIL AD ESS CITY&STATE g ZIP PHONE
SC
DIRECTIONS � � ]�,
TO JOB SITE �� ��V0 duj �(- //z War v
LEGAL ([I SEE ATTACHED SHEET)
DESCR. /'1'� e ic oral e — wbun 1 nztS
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR W /_ {� ^,, �[
BUILDING � r Q�
USE OF J i J l &60 � AY1,[� 16'M-"M -[✓COCA C 7
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
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2 � TWei 0 S1160 112 C 1h V �vvls +t ai�� 1 dart K vn hsa,« �I
Valuation of work: $ PLA4CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
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B DROOMS I DECK CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. _ GARAGE I
ATTACHED � SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT l: OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE i; DETACHED L
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 i
SEASONAL I 1 FLOODPLAIN ;
Firm
E.D. NO. S.E.P.A.
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
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in #
formance therewith. MOTOR VEHICLE PERMIT
LIPAS e1!7 APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
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ate . BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
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