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HomeMy WebLinkAboutBLD8392 - BLD Application - 8/27/1975 - rr zc2 L// r ,1, I-Uf L.J r f WLDIWGrPERMIT APPLICATION MASON COUNTY P. O. Box 400 Shelton, Washington 98584 DATE ISSUED *� ` _ PERMIT NO. d . ?a OWNER MAIL AD DRE89 —i3P PHONE TO JOB SITE ,.r)ZV _ LEGAL I MAIL ADONESS Z1P D' ATTACHED ATTACHED SNEET1 fi' DESCR. EMAIL ADDRESS - PHONE CONTRACTOR .t ' USE OF I MAIL ADORES$ PHONE LICENSE NO. BUILDING o / e Classofwork: NEW ❑ADDITION CI ALTERATION 'Cl REPAIR 1 MOVE CI REMOVE Describe work: v'lrf 0 v y Valuation of work:$ PLAN CHECK FEE — PERMIT FEE v o SPECIAL CONDITIONS: y APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR I A C BY ,Type of Occupancy 4I Const. Group Division Size of Bldg. No.of Max. (Total)Sq.Ft. Stories Occ.Load Cp RAGT©R AFFIDAVIT Spociel Approvals RBquired Rocolved Not floqulrad I Certify that I am a currently registered contractor In the State Gd of Washington and the County of Mason and I am aware of the I-tr~ALT H DEPT. 7`1 ordinance trquirements regulating the work for which the permit PI1 .IWORIC9 Is Issued and all work done wilt be in conformance therewith. MOAt Firm By Lic. No. Date OWNERS AFFIDAVIT I certify that I am exempt from the requirements of the contract or registration law RCW 18.27, and am aware of the Mason County ordinance requirements for which this permit is issued and that all work done will be in conformance therewith. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING. VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC- TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF '`'� 1 _7 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. Owner Date LAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH �i. L{w`aiwG6('d�`�wu4rWcrv. mwuv".w,hw�xwm aw;rH!u;., Walter ` #8392 , ice , hi ., 219-4 Mob iar