HomeMy WebLinkAboutBLD11284 Pole Bldg - BLD Application - 8/24/1981 - BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS CITY&STATE ' ZIP PHONE
OWNER
DIRECTIONS
TO JOB SITE v f �'.✓
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. 73-
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING 4�- --
Class of work: NtOV ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describ"or :
J ,
Valuation of work: $ PLAN CHECK FEE PERMIT FEE S U
SPECIAL CONDITIONS:
BEDROOMS I DECKS �nn ,'ll CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT.� GARAGE.
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ 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 FOR A PERIOD OF 180 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 i_i SHORELINES ❑
SEASONAL Ci FLOODPLAIN ❑
Firm � `
/ E.D. NO. S.E.P.A. ❑
By 1 - " ' G r Special Approvals IN OUT YES APPROVED NO
Lic. No. '6�—y� Date 6 �` O ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
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
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
ICATIONPACEPTED BY PLANS CHECK BY PROVED FOR SUANCE
er Date . B
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K. M.O. CASH
'aw L
00
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z4�X �y�
I
! J�l�►4 r� �� s
Z D �
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5 � 7
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