HomeMy WebLinkAboutBLD7229 Basement - BLD Application - 8/25/1980 1
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED U
PERMIT NO.
OWNER
tNAME MAIL ADDRESS CITY& TATE ZIP PHONE
6 two 7� 5 e AJ,J 9*Sk9c t 6 7 1 .
DIRECTIONS /
TO JOB SITE 2 ,DV'i w -t�;- L e D B s ot-e_ ON h e--, e-v*I C L{'J l o;.^ter �l ♦�
LEGAL / (❑ SEE ATTACHED SHEET)
DESCR. /V S G-J ' 2 b 2 f
CONTRACTOR
NAME MAIL ADDRESt CITY&STATE LICENSE NO. / PHONE
(Z13 fi �Q 3 Z Z
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Z �C �ot get-ti., e.s 1 tt l c��i c,o� by
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
AP Al ION ED BY PLANS CHECK BY A VED FO ISSUANCE Type of Occupancy Division
• B Const. Group
L�
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I certify that I am a currently registered contractor in RESIDENCE
the State of Washington and I am aware of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
'J r wit ZONING c fo
HEALTH DEPT.
Firm A PUBLIC WORKS
By
Qt'e' ROAD DEPT.
Lic. No. ` v L Z f Date Z ,E'6
OWNERS AFFIDAVIT
/ner
at I am exempt from the requirements of the N O T I C E
r registration law RCW 18.27, and am aware SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
ason County ordinance requirements for VENTILATING OR AIR CONDITIONING.
permit is issued and that all work done will
formance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Date. WORK IS COMMENCED.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIO CK. M.O. CASH
L