HomeMy WebLinkAboutBLD5737 Mobile Home - BLD Permit / Conditions - 8/12/1977 Minot, Rita #5737
8-12-77
SE 1/4 SE 1/4 NE 1/4 34-21-3
Mobile Home y,�;
Y
.� BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 ff
DATE ISSUED
PERMIT NO.
OWNER / NAME M �+ C & TAT ZIP PypNE
DIRECTIONS V +v p pf0
TO JOB SITE I I/ —
LEGAL' L, )) �j Cj �/ (❑SEE ATTACHE SHEET)
DES CR.r /►' P' o/� (YiC , /I l
CONTRACTOR
NAM,_ MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING Al
Class of work: ❑ NEW ❑ ADDIT ON ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
f - 12
7 $-11 E.
U
,AaI ation of work: $ PLAN CHECK FEE PERMIT FEE 0
S ECIAL ONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
BY Const. Group
`� `•`J 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
conformance therewith. ZONING
HEALTH DEPT.
Firm PUBLIC WORKS
By
ROAD DEPT.
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be i conformanc therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
�1 SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owner Ors Date. WORK IS COMMENCED.
AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK M.O. CASH