HomeMy WebLinkAboutBLD9955 Travel Trailer - BLD Permit / Conditions - 8/16/1976 Royce, Delbert #9955
8- 16-76
Mission Creek Tracts Div. 1 Lot 3
Travel Trailer
BUILDING PERMIT APPLICATION
MASON COUNTY3
Zz
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED (,/7
PERMIT NO. C�C-5
NAME MAIL AD_ ESS CITY 8 STA P PHONE
OWNER f 19 f N U/Q
1
DIRECTIONS
TO JOB SITE
(0 StE ATTACHED SHEET)
LEGAL
(�' `/i'l G�/� /V'.�if/ �
DESCR.
NAME
MAIL ADDRESS CITY 6 STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Descri work
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
Occupancy Division
APPLICATION ACCEPTED BY, PLANS CHECK BY APPROVED FOR ISSUANCE Type of Const. 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
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 i onfor anC@ th@r Ith. 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 1� Date. 4 WORK IS COMMENCED.
PL. '�CK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH