HomeMy WebLinkAboutBLD10102 Wind Damage - BLD Application - 2/25/1981 BUILDING PERMIT APPLICATION
� 4
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 /
DATE ISSUED ,2
�e n PERMIT NO.
OWNER ME MAIL AUPEIESS CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. G
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR /- _ _ 33
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
' / 1
cal
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE c ��
3 vcjo
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
ATTACHED CJ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATIN
NO. OF STORIES BASEMENT ❑ 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 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 LJ SHORELINES I J
��� &/ SEASONAL [] FLOODPLAIN I J
Firm S p�i-S
E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. 3 ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I ertify that I am exempt from the requirements of the FIRE MARSHAL
ontract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for -Oi LDING DEPT.
which this permit is issued and that all work done will SOTOR)VEHICLEPEPMI
S
be in conformance therewith. T
E BY PLANS CHECK BY VED FOR U COwner Date . �IFI
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH