HomeMy WebLinkAboutBLD10024 Dock - BLD Application - 2/24/1981 BUILDING PEkMIT APPLICATION
MASON COUNTY
�(1'�� P.O. Box 186 Shelton, Washington 98584
d 426-5593
DATE ISSUED o•� )/7� !�
PERMIT NO.
OWNER NAME IF MAIL ADDRESS CITY 8 STATE ZIP PHONE
1:201kcL m 51 ms 20 a Kee e
DOJOBISrI T TE4of3b, 01 thf, 6 /d -c InaSo� Ldke
LEGAL A) It C O77 y+Od SEE ATTACHED SHEET)
DEscR. ��^ "'`d� atBly at'L1&�r >~ond -tore �t�c+�tr�dY�o+�a/ dyed
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR lV 0 If 67
USE OF
BUILDING /V0-f X PP "'Ca .h lam'
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
�_6 D o vG e . Yi
6
0
Valuation of work: $ �E3 PLAN CHECK FEE " PERMIT FEE ',
-A5616 %~
SPECIAL CONDITIONS:
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 ❑ IDETACHED ❑
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 i i SHORELINES I i
SEASONAL f] FLOODPLAIN
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT. 0
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
/ner
rtify that I am exempt from the requirements of the FIRE MARSHAL
tract or registration law RCW 18.27, and am aware
the Mason County ordinance requirements for DING DEPT. // f
ch this permit is issued and that all work done will ROAD ACCESS
i conf rmance the rewi OR VEHICLE PERMIT
r
OBY
Date_!�Iwi� PPLI ATION ACCEP`E Y PLANS CHECK BY APPROVED FOR ISSUANCE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH