HomeMy WebLinkAboutBLD4280 Mobile Home - BLD Permit / Conditions - 2/7/1977 Burrows, Richard C. #4280
2-7-77
Collins Lake Div. 3 Lot 76
Mobile Home
t BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATEISSUED a
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
k''c lea rd C. v
DIRECTIONS
TO JOB SITE
LEGAL '`( SEE ATTACHED SHEET)
DESCR: lam"' Y .2 itsr�
CONTRACTOR NAME MAIL ADDRESS CITY&STATE LI ENSE N PHONE
OC) e iOA L13 6 S 7 -953
USE OF
BUILDINGL H'Qm
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ _ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY PROVED FOR ISSUANCE Type of Occupancy Division
Y •� �/ � Const. Group .�-
'�rt
Size of Bldg. No. of Max.
(Total) Sq. Ft. � Stories Occ. Load �d
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
�� 1/ ^ ��£S HEALTH DEPT.
Firm � ��'C cx� PUBLIC WORKS
By \�� � ROAD DEPT.
Lic. No. �� L 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 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
0 er Date.2 e2 7 7 WORK IS COMMENCED.
PL CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH