HomeMy WebLinkAboutBLD6298 Floats - BLD Application - 5/1/1980 • BUILDING PERMIT APPLICATION
• MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NAME IL ADDR SS CITY&ST TE IP PHONE
DIRECTIONS + gCj - S L!
TO JOB SITE W b '. .} Y)10 yn
LEGAL 1 j�/ (❑ SEE ATTACHED SHEET) _ a_3
DESCR. C a r� G /7 �V`
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
b ip ip-e A
USE OF 1
BUILDING hav t h a A
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE o.d
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE LJ
ATTACHED [I SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT IJ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED LJ
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 1
SEASONAL [J FLOODPLAIN [J
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 rtify that I am exempt from the requirements of the FIRE MARSHAL
ntract or registration law RCW 18.27, and am aware BUILDING DEPT.
f the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
APP ION AC Y PPLLAANP ECK BY APPROVED FOR ISSUANCE
Owner �' ate � 0 BY��
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH