HomeMy WebLinkAboutBLD11595 Community Center - BLD Application - 10/16/1981 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED to
PERMIT NO. �f L9u
OWNER NAME MAIL ADDRESS CITY 3 STATE ZIP PHONE
oAl RONSON LIA-ly 7-Er
DIRECTIONS
TO JOB SITE /0230 IVAgo /Ck� Del
LEGAL �j (❑ SEE ATTACHED SHEET)
DESCR.CONTRACTOR -
NAME MAIL ADDRESS CITY d STATE LICENSE NO. PHONE
Atf / //I a usT6�
USE OF
BUILDING
Class of wor 0ERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
fcJ D / p /
C
i
Valuation of rk: $ J PERMIT FEE
p
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT Ll NOTICE
BATHROOMS TOTAL SO. FT._-- GARAGE ❑
ATTACHED L� SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT 1-1 OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ IDETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 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 i I SHORELINES L]
SEASONAL [', FLOODPLAIN i_]
Firm
E.D. NO. _ S.E.P.A. []
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT. d /Jr / f 6 U
OWNERS AFFIDAVIT HEALTH DEPT. (��,•V,AI Iola-ti
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 ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
AP LIGATION A CEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Ownef1,L Date .�046 BY �
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
BUILDING PERMIT APPLICATION •
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 LD ,/
DATE ISSUED h
9L2 000 4�0 PERMIT NO.
OWNER NAME MAIL ADDRESS CITY 6 STATE ZIP PHONE
tf5QA1 -NS �6r
DIRECTIONS
TO JOB SITE /,Z D /�
LEGAL (❑ SEE ATTACHED SHEET)
DESCR.
C NAME MAIL ADDRESS CITY d STATE LICENSE No. PHO
-�,,,„ONTRACTOR
� o —' uST6E �G— ��33
USE OF M,
SJILDING AtiT rX
Class of wor LMDU---"t_TERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
G GJ b INV 7 la k l- /
�— o
Valuation of work: $ PLAN CHECI(FFD PERMIT FEE 4/
Soon( `7 ]'
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. _ GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 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 ❑
SEASONAL ❑ FLOODPLAIN ❑ •
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT. 51-iI /Z,,*��✓ DHI
OWNERS AFFIDAVIT HEALTH DEPL---' 10-1641 10 � QA
PUBLIC WORKS
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.777
which this permit is issued and that all work done will ROA CESS
be in conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date / BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
