HomeMy WebLinkAboutStorage - BLD Application - 11/10/1981 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
41.7 001 O 426-5593 /
DATE ISSUED /Y""
PERMIT NO.
OWNER NA WE MAIL ADDRESS CITY 8 STATE ZIP PHONE
DIRECTIONS TO JOB SITE .� ��1+- !r
LEGAL (❑ SEE ATTACHED SHEET)
DESCR.
NAM ✓ MAIL ADDRESS ITY 8 STATE LICENSE NO. PHONE
CONTRACTOR Ise
USE OF )_
BUILDING rfly)
Class of work: NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
sa zzz
s�
- ._ o
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS: [
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS ITOTAL SO. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, 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 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 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. a
is permit is issu and that all work done will ROAD ACCESS
nformance th with. MOTOR VEHICLE PERMIT
`Li
/�j AP L CATION ACC T D Y PLANS CHECK BY APPROVED FOR ISSUANCE
- -= Date._T � BY r"")
PLAN CHECK VALIDATION CK. M.O. CASH PE IT VALIDATION CK. M.O. CASH