HomeMy WebLinkAboutBLD7733 SFR - BLD Permit / Conditions - 10/19/1977 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED ryAQ —/!7-:I':
ERMIT NO.
OWNER NAME MAIL ADCAESS CITY&STATE ZIP PHONE
DIRECTIONS Cti I
TO JOB SITE J— a.
LEGAL ( (❑ SEE ATTACHED SHEET)
DESCR. 6 `.5�.- �i - �`� wt
CONTRACTORI en
N ME AIL ADDRESS CITY&STATE LICENSE NO. PHONE USE OF I
�
BUILDING ze 9
Class of work: gNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe wor!7:�" Z'
Valuation of work: $ �'" J yJ PLAN CHECK FEE 93S-o PERMIT FEW7 M
SPECIAL CONDITIONS: /
APPLICATION ACCEPTED BY1 PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
BY Const. Group
.� �. /Z —
Size of Bldg. No. of Max,
(Total) Sq. Ft. Stories Occ. Load p
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 p con formanc erewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
/'/ SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Ow Datp/g :Z WORK IS COMMENCED.
P CHECK VALIDATION CSC/ M.O. CASH PERMIT VALIDATION K. M.O. CASH