HomeMy WebLinkAboutBLD4956 Concrete Slab for Pump House - BLD Application - 9/17/1976 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 96584
DATE ISSUED—%��Z/-7
(zvao PERMIT NO. �-ScG
OWNER MAII_ DRE CITY&STAT 1g,_ PHONE
DIRECTIONS
TO JOB SITE �10A elj `Mvl `�L (���/ Ct JI C� ( (C� �e�
LEGAL V (❑ SEE ATTACHED SHEET)
NAME MAIL A ESS CITY R STATE LICE BE NO. PHONE
CONTRACTOR
USE OF e
BUILDING
Class of work: NEW ❑ 'ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: 5 . /1 - I
Vow/ ��lC r t {^� c�egv fa n 4_41_� vY
I /.[C` � I O ftY l v C� �L! L..�c�o-c cln . ��kr;-- �9 �� ��1�►'1�u.�.1c. � ('B c.
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Valuation of work: $ // �74 dCJ PLAN CHECK FEE PERMIT FEE -�
W /
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY! PLANS CHECK BY �JAPPROVED FOR ISSUANCE Type of Occupancy Division
Const. Group
i
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
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
ontract or registration law RCW 18.27, and am aware PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
Of the Mason County ordinance requirements for SEPARATE
VENTILATING OR AIR CONDITIONING.
whic permit is issued and that all work done will
I OnfOr ce 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
wn Date, WORK IS COMMENCED.
LAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. ASH
