HomeMy WebLinkAboutBLD4200 Mobile Home - BLD Permit / Conditions - 2/7/1977 Stafne, Michael #4200
2-7-77
Mading's Sunnyshore Addn. #6 Tr. 43
Mobile Home
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BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 7 7�
DATEISSUED
PERMIT NO. �a
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER j.S--TA.F-rje M IC N/ML RVJ vg8`l� CN$k 17
DIRECTIONS
TO JOB SITE
LEGAL , SEE ATTACHED SHEET)
DESCR. Ad"'K-1 *4� � JA��.t J� -
CONTRACTOR NAF# MAIL ADDRESS CI &STATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
APPLICATION ACCEPTED Y PLANS CHECK BY E:W;:
Type of —� Occupancy Division
Const. 1 / Group
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load 1/63
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 SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
of the Mason County ordinance requirements for VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be In conformance therewith. 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
Owne Date. Z WORK IS COMMENCED.
P N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH