HomeMy WebLinkAboutBLD4792 Addition - BLD Permit / Conditions - 1/2/1980r
Christensen, Juanita #4792
5-17-77
Plat of Mission Creek Lot 12
Contractor
Osterman Concrete
Addition
$7,616.00
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED
PERMIT NO. / Z
OWNER TAME MAIL ADDRESS CITY&STATE ZIP PHONE
e.kii
DIRECTIONS // ,7�•�y, /j�;/��d H.SSecy,c,
TO JOB SITE ��� z t'O /L9i - G'M �Co9�( r/lroi
t)ligtie-
LEGAL / / (O SEE ATTAC ED SHEET)
DESCR. e. I � A� �J S O CtZ ee- ` ' 24- -2�m
C-
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
s eicu-r 0 2'1 3 Be;IC z J - --r- ZC-C -lc;
USE OF 1
BUILDING n �` ld O kt
1
Class of work: ❑ NEW Ok ADDITION ❑ ALTERA ON ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
i r-l q / o VA
V&4 fit`
r 1 � /
d rL' L " L4>19 (�S
Valuation of work: $ 7) PLAN CHECK FEE //^ PERMIT FEE
SPECIAL CONDITIONS: J7
APPLICATION ACCEPTED BYl PLANS CHECK BY APPROVED FOR ISSUANCE Type of / Occupancy Division
BY Const. / Group
i L') i
Size of Bldg. No. of Max.
(Total) Sq. Ft. yY Stories J Occ. Load f�
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 -�
By
Firm �Zi-t PUBLIC WORKS
ROAD DEPT.
"
Lic. No. f-T -2 -C2 ��% Date i
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.
P AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH