HomeMy WebLinkAboutBLD N/A Demo - BLD Application - 2/29/1980 BUILDING PERMIT APPLICATION
.. MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED �— a Ed
2 3�� PERMIT NO.
OWNER NAME MAIL ADDRESS CI ST T ZIP PHONE
AV
DIRECTIONS
TO JOB SITE
LEGAL (❑ SEE A AC D SHEET)
DESCR. 13, T*,C44ftC' C Y$- _ 22 Z 3LC/Z5
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING �/—'—
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE REMOVE
Describe work:
�I
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT LI NOTICE
BATHROOMS TOTAL SO. FT. GARAGE LI
ATTACHED I SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT Ll OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE 1.1 DETACHED C!
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT 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
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 I 1 SHORELINES
SEASONAL IL; FLOODPLAIN L I
Firm
E.D. NO. S.E.P.A. I I
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 a O
of the Mason County or inance requirements for BUILDING DEPT.
VSc
it is iss and that II work don will ROAD ACCESS
e th eO ith. MOTOR VEHICLE PERMIT
�wn
ICATION AC PTED Y PLANS CHECK BY APPROVED FOR ISSUANCE
er e. B
N10
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION M.O. CASH
• ' • BUILDING PERMIT APPLICATION
MASON COUNTY
) Z33Z �� �
'5TR A P.O. Box 186 Shelton, Washington 98584
'00/80 426-5593
�7S .a 3a s/ DATE ISSUED
(Tqk/ ,�T 51*1,971l, -I?S PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
` C/TY C"P'
DIRECTIONS
TO JOB SITE Iv S+uT O w e
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. r Cr 13 . 7IVo ,l _ �-
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING 4e/y1diAl, C 6' E
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOV
Describe work: _
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS_ _ CARPORT [ I NOTICE
BATHROOMS TOTAL SO. FT. GARAGE [I
ATTACHED [J SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT i '. OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE I DETACHED Cl
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT 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
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 i_i SHORELINES i_!
SEASONAL [ 1 FLOODPLAIN [ 1
Firm E.D. NO. S.E.P.A. [ I
By Special Approvals IN OUT YES APPROVED NO
Lie. 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 BUILDING DEPT. it 2 (,�
of the Mason County ordinance requirements for
which this pe mit is issued and that all work done will ROAD ACCESS
b in confor ance erewith. MOTOR VEHICLE PERMIT
APPL TI ACCEP D BY PLANS CHECK BY APPROVED FOR ISSUANCE
ate BY n
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
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