HomeMy WebLinkAboutBLD N/A Addition - BLD Application - 1/18/1983 BUILDING PERMIT APPLICATION
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MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
• PERMIT NO.
OWNER NA MAILADDRESS CITY 6 STATE ZIP PHONE
DIRECTIONS r
TO JOB SITEk�2SU_0
LEGAL 0 V-- - (❑ SEE ATTACHED SHEET)
DESCR. q i a04A
NAME MAIL ADDRESS CITY 6 STATE LICENSE NO. PHONE
CONTRACTOR �.� 9 ,c/�n 'd1. T /D
USE OF V
IDYL c
BUILDING
Class of work: ❑ NEW VADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
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Valuation of work: $ PLAN tHECK FE PERMIT FEE
SPECIAL CONDITIONS:
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BEDROOMS I DECKS _ CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, EATING. VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED ❑
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 h
14
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT. G [< 7F
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL nz
contract or registration law RCW 18.27, and am aware are 4ajjvl
of the Mason County ordinance requirements for BUILDING DEPT. 3
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
G APPLICATION ACCEPTED BY I PLAN CHECK BY APPROVF FOR ISSUANCE
Owner Date — 6 lj 0 BY�
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PLAN CHECK VALIDATION CK. ,M.O. CASH PERMIT VALIDATION CK. M.O. CASH