HomeMy WebLinkAboutBLD11463 Install Firewall - BLD Application - 9/23/1981 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED ( �3 1 O
�Rl.urerlN NL�5o. PERMIT NO. IN4 -3
OWNER
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
Je. o QZ
DIRECTIONS C S1a)
TO JOB SITE 113 o t
1 Cl
LEGAL ��jj (❑ SEE ATTACHED SHEET)
DESCR. 3 11�K ,/ /�-C�I `Q v"t— i 2 —ZZ —3
AME M ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR oil- 3-0/
USE OF
BUILDING CQ q, I
Class of work: ❑ NEW ❑ ADDITION ><ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
A a- r Q 1' ro ✓ edi v
Stirs r ALrage, e—tXV et i well-Y. f}CIG Ge_
Valuation of work: $ 00
ds PLAN CHECK FEE PERMIT FEY `O
IWI s J
SPECIAL CONDITIONS
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
BY Const. �2 Group
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.
fij�e MA s /
L1c. No.iz3-C t &ak- 0"*'970041 Date
R
cYc
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
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be in conformance 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
Owner Date. WORK IS COMMENCED.
PI3W CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH