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HomeMy WebLinkAboutBLD18521 Replace Gasoline Pump, Canopy - COM Application - 4/16/1986 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 DATE ISSUED �Y h PERMIT NO. OWNER NAME MAIL ADDRESS CITY&STAT /' I ZIP PH NE P © o he a G t/ fP `�Z , DIRECTIONS �p 1 TO JOB SITE Du S 0 La Kc 1`01 , yy 8 A be T a e- �_,'me y,c Lem T LEGAL / (❑ SEE ATTACHED SHEET) DESCR. D i L) y 0 7 r d her c Mel -" i C l� 1 Q P NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE CONTRACTOR &b ) e C( -A P 0 5%o\ P m 2!b 2`7�/�J USE OF n / BUILDING e Y . S Ta?t eve Class of work: ❑ NEW ❑ ADDITION n ALTERATION "EPAIR ❑ MOVE ❑ REMOVE Describe wor . Valuation of work: $ ` PLAN CHECK FEE PERMIT EE SPECIAL CONDITIONS: BEDROOMS DECKS CARPORT ❑ NOTICE BATHROOMS TOTAL SQ. FT. GARAGE ❑ ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES BASEMENT C] 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 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 c nformance therewith. PERMANENT ❑ SHORELINES 11 SEASONAL ❑ FLOODPLAIN ❑ Firm E.D. NO. S.E.P.A. ❑ By Special Approvals IN UT YES APPROVED NO LI 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 �G BUILDING DEPT. of the Mason County ordinance requirements for which this permit is issued and that all work done will ROAD ACCESS be in conformance the with. MOTOR VEHICLE PERMIT APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Owner Date.— PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH CHRISTMASTOWN PRINTING