HomeMy WebLinkAboutDemo - BLD Application - 6/22/1981 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
9 ,450 _ ��� DATE ISSUED � /
IIJJ PERMIT NO. � 'J
OWNER NAM MAIL I��R S i C 8 STATE —0 ZIP HONE
DIRECTIONS C/T/• a LTL 12q 3-14
TO JOB SITE
LEGAL "- (, ATTACHED SHEET)
DESCR. Ar-ke- -
NAME MAIL ADD SS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
ENG 7z)ell?? /r flLoN
Class of work: ❑ NEW El ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE REMOVE
Describe work: J'
� c vim'e
Valuation of work: $ PLAN CHECK FEE ,L / PERMIT FEE
,00
SPECIAL CONDITIONS: �j(1
BEDROOMS {DECKS CARPORT ❑ NOTICE
BATHROOMS I TOTAL SO. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR, PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT [] OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE I I 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 FORA PERIOD OF 180 DAYS AT ANYTIME 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. PERMANE SHORELINES
SEASONA ❑ FLOODPLAIN
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT
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 BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conforman t erewith. MOTOR VEHICLE PERMIT
MPPLTI N EPTED PLANS CHECK BY APPROVED FOR ISSUANCE
Date. i BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH