HomeMy WebLinkAboutBLD12715 Mobile Home - BLD Application - 7/14/1982 BUILDING PERNOT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED 7`r
PERMIT NO. ,� J
OWNER NAME ADDRESS CITY&STATE ZIP PHONE�
DIRECTIONS
TO JOB SITE Q Ike L i yv, io
LEGAL r (❑ SEE ATTACHED SHEET)
DESCR. LG� I�c L 1�1 \ \') , Ia *
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR " \j L4 6 �.
USE OF �1
BUILDING Q I- Y„%6LVVAr C
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: 11 / �
/� S ,
Valuation of work: $ / PLAN CHECK FEE PERMIT FEE as
SPECIAL CONDITIONS:
94M,4-w_M
Jef joga� ;;?;P� 44�lzl'
BEDROOMS DECKS — CARPORT ❑ NOTICE
BATHROOMS__ TOTAL SQ. FT._ GARAGE [!
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
S ❑ ATTACHED ❑
NO. OF STORIES BASEMENT OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE C] 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 ]
SEASONAL ❑ 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. Q'-2 la
which this permit is issued and that all work done will ROAD ACCESS
be in conforma ce therewith. MOTOR VEHICLE PERMIT
9 -7 ` P LIGATION ACC D AY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date. / / BY
V 1[&d.
PL CHECK VALIDATION CK. M.O. CASH IVERMIT VALIDATION CK. M.O. CASH