HomeMy WebLinkAboutBLD N/A Shed Lot 51 - BLD Application - 10/1/1981 4 BUILDING PERMIT APPLICATION eA�
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
o, 426-5593
DATE ISSUED
Uff %I PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&CSTTA_TE d ZIP PHONE
DIRECTIONS
TO JOB SITE �s,�� d T Gia4ocu v t.sesv� L�Ct /�+x%d
LEGAL (C7 SEE ATTACHED SHEET)
DESCR. • 1t
CONTRACTOR
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
;USE OFILDING
Class of work: XNEW ❑ ADDITION Ll ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
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Valuation of work: $ PLAN CHECK FEE PERMIT FEE /7
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SPECIAL CONDITIONS:
x
BEDROOMS CKS 9ARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT L] OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE 11 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. -� - � c�
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner^� v Date / /O
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
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