HomeMy WebLinkAboutBLD11703 Mobile Home - BLD Application - 11/12/1981 • . 1 N ,earl� � /
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
"r 426-5593
4 " DATE ISSUED--
PERMIT NO. Q
OWNER N ME IL ADDRESS CITY&STAT ZIP PHONE
--�- - 1.
S7 1 �4
DIRECTIONS _
TO JOB SITE
LEGAL / (O SEE ATTACHED SHEET)
DESCR.
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR C! s P S LUG
USE OF
BUILDING
Class of work: %,NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ ^G PLAN CHECK FEE PERMIT FE
SPECIAL CONDITIONS:
BEDROOMS {DECKS CARPORT El NOTICE
BATHROOMS (TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ( ] OR AIR CONDITIONING.
TOTAL SQ. FTl L-( FIREPLACE [I 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 SHORELINES ❑
SEASONAL f-1 FLOODPLAIN Ci
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC RKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
l �� AP ICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owne �`t O Date / �/
PLAN CHECK VALIDATION CK. M.O. CASH MHMIT VALIDATION CK� M.O. CASH