HomeMy WebLinkAboutBLD11143 Mobile Home - BLD Application - 8/4/1981 • BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 !
DATE ISSUED l�
� iXG• PERMIT NO. l V3 T
v
OWNER
NAME MAIL ADDRESS CITY 8 STATE. PHONE
Q„
DIRECTIONS �o �a[� J —TO JOB SITE[7)
_
LEGAL (❑ SEE ATTACHED SHEET)
DESCR.
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR
USE OF ti
BUILDING
Class of work: [],NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: '
7
7 yak. 77 as-
Valuation of work: $ PLAN CHECK FEE PERMIT FEE,
SPECIAL CONDITIONS:
BEDROOMS {DECKS CARPORT NOTICE
BATHROOM (TOTAL SQ. FT. GARAGE [7
ATTACHED� SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATI
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. 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 FORA PERIOD OF 180 DAYS AT ANYTIME 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 c rtify that I am exempt from the requirements of the FIRE MARSHAL
ntract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be irl conformance therewith. MOTOR VEHICLE PERMIT
DLI TION CEPTED BY PLANS CHECK BY APPROMOISSUAVCE
O{/wn-Jer G — Date . BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATI CK. M.O. CASH
I