HomeMy WebLinkAboutBLD8555 Roof - BLD Application - 10/2/1975 BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584
�J f3�' DATE ISSUED— 0- - _7-5 —
-- � 4, a X T�S v ---- --- - -- ----- PERMIT N 0. e5
OWN-ER ice`= �-.� MAIL ADDRESS ZIPS+ PHONE / '
DIRECTIONS
` TO 10B SITE
LEGAL MAIL ADDR S6 D ZIP f-1aLL ATTACHED SHLLTI
MAIL ADDRESS PHONE
CONTRACTOR
USE OF MAIL ADDRE P3 PHONE LICENSE NO.
BUILDING
Class of work: ❑NEW ❑ADDITION aALTERATION ❑ REPAIR ❑MOVE ❑ REMOVE
Describe work:
Valuation of work: $ LI Fa/�/) PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS: `T t�C
APPLICATION AC'EPTED BY PLANS CHECKED BY APPROVED FOR UA CE BY
Type of Occupancy
�- onst. Group Division
-•--- --- Size of Bldg. No.of Max.
(Total)Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT Spacial Approvals Required Received Not Require
I Certify that I am a currently registered contractor in the State _NN
of Washington and the County of Mason and I am aware cf the HEALTH DEPT.
ordinance requirEments regulating the wcrk fcr which the permit 1=09LIC WORKIIIIII
is issued and all work done wi:l be in conformance therewith. AMD pEFrr,
Firm
By _
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the contract _
or registration law RCW 18.27, and am aware of the Mason
County ordinance requirements for which this permit is issued and that all work done will he in conformance therewith. N 0 T I C E
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING,
HEATING. VENTILATING OR AIR CONDITIONING.
(1wn , ate Q/ 1-7s - THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC-
TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF
120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
LAN CHECK VALIDATION cK M.O. CASH PERMIT VALIDATION CK. M.O. CASH,
SHELTON PRINTING CO.