HomeMy WebLinkAboutBLD11950 Roof - BLD Application - 1/22/1982 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 Q
426-5593 / a
DATE ISSUED / `— v
PERMIT NO. �l��
OWNER N�M IMAAILIkDDRESS CITY&STATE L ZIP PHONE
DIRECTIONS //
TO JOB SITE �L {Q f 0 ✓pL/�U 11�� /����-ez/
LEGAL /� O 1[ � (❑ SEE ATTACHED SHEET)
DESCR. / li1- C/�-/L1� d 0
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDINGf
Class of work: I NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEA ��
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE Ll
ATTACHED i_; SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT Li OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE L 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 ,_i SHORELINES I J
SEASONAL LI FLOODPLAIN I 1
Firm E.D. NO. S.E.P.A. 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 BUILDING DEPT.
of the Mason County ordinance requirements for
which t ' permit is issued and that all work done will ROAD ACCESS
be i c formance t erewith. MOTOR VEHICLE PERMIT
mLICATIO C EPTED BY PLANS CHECK BY APPROVED
/FOR ISSUANCE
Owner Date . /
CK. M.O.
PL CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CASH