HomeMy WebLinkAboutBLD7012 Finish SFR - BLD Application - 7/31/1980 l
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
! ' �J
E R M I T NO. Z
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
o/V A LD , C 1-,8 iVP L C-OM 14 WA 3'04 7 ` -
DIRECTIONS
TO JOB SITE
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. �/1 ACT 8 6 %1 A D/`it/G S 41111N t .f'f��?�` AO G
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING RE G R,EA00AI C If 16/N
Class of work: ❑ NEW ❑ ADDITION ALTERATION YCE,
EPAIR ❑ MOVE ❑ REMOVE
Describe work:
likti-v4 esi�d
7
Valuation of work: $ v gyp* PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS {DECKS CARPORT I I NOTICE
BATHROOMS (TOTAL SO. FT. GARAGE []
NO. OF STORIES BASEMENT I I
ATTACHED i 1 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE I i DETACHED
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
CONTRACTOR AFFIDAVIT 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
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 ❑ SHORELINES I
SEASONAL [] FLOODPLAIN Ll
Firm
E.D. NO. S.E.P.A. 'I
By Special Approvals IN OUT YES APPROVED NO
Lic. No, Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will OAD ACCESS
be in conformance therewith. M TOR V. CLJE PERMIT
s PLICATION tCj EPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner __ Date �J � I BY
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PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION (,CK. M.O. CASH