HomeMy WebLinkAboutMIS95-00905 Cancelled Storage - MIS Application - 11/17/1995 Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT ---
#1eSite
er `> > /�� Phone#
Addr ss t! �5�. f Fire District# .11)
5 St ��- Zip ��YS 7
Directior)s to Job Site '' %� u'�� '"
Owner Mailing Address
City St Zlp s
Lien/Title Holder
Address
City St Zip
#2 Contractor Name .49W 104'` Z V-�f,4e/0 Contractor Reg#dkhWle e oj-g6q
Address , ?q ''P 7 �>tfi ��� Expiration Date C �/
City 5� AJ^M-y St )/� Zip �� Phone #��l'C --'?y7- 79Y"7
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well J�
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 arcel No. - �� - ��OiA
egal Description .�� r -3he/`f I.4t
#5 Building Square Footage: (existing/proposed)
1st FI 1d60/ 2nd FI / 3rd FI / Loft /
Basement / Deck / # bedrooms / # bathrooms —/—____
Garage / Carport / (Circle: Attached or Detached?)
Other sq. ft. /
#6 Use of building 5 l me- i-j' r+, h1' �� + Describe work
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#7 Type of Job: New ✓ Add Alt Repair ha T
M
#8 MOBILE/MAN F5TURED HOVIE,INFORMATION NOV 5
Model Year Make 4i Model 416
Length Width --�T Serial No. 3--1-270
# Bedrooms # Bathrooms Type of Heat / j 'ept'/ HEALTH SERVICES
Purchase Price $ `� L?�
#9 Indicate by circling the applicable source if any water is on or adjacent to subject property:
River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other __