HomeMy WebLinkAboutBLD11499 ReRoof - BLD Application - 9/29/1981 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 9��? 9 d/
�f 4f Gj/�/ �/� DATE ISSUED
3 2. I 3 '-- 1 A 1 wax V PERMIT NO.
OWNER NAME MAIL ADDR ITY&STA E � 21P PHONE
DIRECTIONS
TO JOB SITEAc4zoss t Q dLEGAL i
DESCR. ,3.a I- 3 1� es�L- �/� �/' wsi � ^r 6t❑ SEE ATTACHED SHEET)
NAME vC/C MAIL ADDRESS(f r" N/CJ( CITY&STATE `�/}G'LICENSE O. PHONE
CONTRACTOR
tl
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
Des rlqrw
a work:
3 5' C
Valuation of work: $ PLAN CHECK FEE PERMIT FEE #
/ / O
SPECIAL CONDITIONS: ,
ow 'ev
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED 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 ❑
SEASONAL ❑ FLOODPLAIN ❑
Firm
E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
.ic. 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. ?
11
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
r Q O\A_dn�'_ Date. �� Q/ APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
NJ
I�ICQj, 'I9 !/
CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK M.O. CASH