HomeMy WebLinkAboutBLD4556 - BLD Application - 4/4/1977 BUILDING PERMIT APPLICATION
P.O. Box SITtrVafttI 98584
TLI UED w . / ,/;
S11-147- j
iL CITY CT t IP PHONE
RECTIONS
TO JOB SITEj h RI 1 Lt/e &c cRI / P# da)
AI HOEl)
HA L . PHONE
Class of work: P NEW vl ADDITION C" ALT RA I l REPAIR # ... . ,: t E....k..
Describe work: �... �.
Valuation of work. FLAN CHECK FED PERMIT FEE
SPECIAL CONDUIONS:
TION � I t t C ICY C C t P IC t9 FIEF T I of 0ectip nc ivision
Ccirwst, Group
Yn of S No, cif max.
(Teat tl t, tonmsOc^ , LiH
CCTAT3 A tAtl# a EPFP ANENT SEASONAL ,D.NUMBER
I certify that I am curr ntly registered contractor in i r t� ,_.
the State of Washington and I im ware of the iL
O dinanee requirementsregulating the wok ftar ar riich
the permit I cued aid 1done well iaw f a d', p o7si tr i rtev& Nof i
conformance Ito ewth CNN
IALl't I PT
Firm OIELIC W(F
By At PT
Lic. N . Dat
OWNERS AFFIDAVIT
I certify that I am exempt fr m the requirementsIII N
contract or registration aw A W 18 27 nd amawareEPA F PFPf I i PE UIRED FGTI ELECTRICAL, PL VMS IN , @ TING
of tie Mason County ordinance requirements Ir r ENTILAT`I G +rt MR t"f fiYIONI i .
wt f this per ia ssued and that all + r wIIS
be I cod nr racc the r with T trIC PERMIT t FC F iltLL AArt3 IC:3I IF YCRN N T RUCTION AUTHORIZED
IZ
9R rT COM IMENC ITHIN 120 DAYS, CSR I N CONSTRUCTION 8R WORK I
SU PENDED OR PAN NED FORA PFRICI£T OF Tel DAY Al" ANY TI AFTER
Owner Date. WORK I 0 W N P
LCHECKVALDA11JN OK M.C CA I ALI AiI N K M.O.