HomeMy WebLinkAboutBLD2185 Addition - BLD Permit / Conditions - 5/12/1978 Lillehei, George Jf2185
5-12-78
Tahuya River Valley Tr. Lot 14 Div. 2
Addition ( Carport, Wash room, Patio)
$4,719.00
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL AM CITY&STATE ZIP PHONE
WAI
DIRECTIONS 4-1
TO JOB SITE
4
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. Si9--*1e /f V 6?-
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING Ile 10+4 ct=
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: ,ZS1sy L st
7 orT I.2x` / X1g)
Valuation V o
PLAN CHECK FEE PERMIT FEE
tz
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY AP MOVED FOR ISSUAUeE Type of Occupancy Division
B Const. Group
_Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVI
PERMANENT SEASONAL E.D.NUMBER
I certify that I am a cure tly r stered contractor In RESIDENCE
the State of Washing d I am aware of the MOBILE HOME
ordinance requirem t gulating the work for which
the permit is iss nd all work done will be in Special Approvals Required Received Not Required
conformance t ewith. ZONING
HEALTH DEPT.
Firm PUBLIC WORKS
By
ROAD DEPT.
c. 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.
4bi
' permit is issued and that all work done will
formanc er — TH PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
if
NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
' SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Date. r WORK IS COMMENCED.
p�q�
'nK VALIDATION CK. M.O. CASH PERMIT VALIDATION ICK. I M.O. CASH