HomeMy WebLinkAboutBLD4922 Move Mobile - BLD Application - 9/10/1976 e �r
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 `
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL f i '',Ce (❑ SEE ATTACHED SHEET)
DESCR. - . 3 N �l W 4/, M• 90 Gout117
MAIL ADDRESS CITY&STATE f LICENSE NO. PHONE
CONTRACTOR !I
AJPZ
USE OF ` l��ll�
BUILDING
Class of work: ❑ NOV ❑ ADDITION ❑ ALTERATION ❑ REPAIR MOVE ❑ REMOVE
Describe work:
Valuation of work: $ �g PLAN CHECK FEE PERMIT FEE 26
SPECIAL CONDITIONS:
AP CATION EP ED BY PLANS CHECK BY l�PROVED FOR ISSUANCE Type of Occupancy Division
FYI n J�I j C nsI Group
Size of Bldg. �. No. of , Max.
(Total) Sq. Ft. 7�D 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
ROAD DEPT.
By
Lic. 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.
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 Dat tjn WORK IS COMMENCED.
67
PLA HECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK.'+ M.O. CASH