HomeMy WebLinkAboutBLD10997 Woodstove - BLD Application - 7/14/1981 +� BUILDING PERMIT APPLICATION
" R MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO._za
;DI
NER ME MAIL ADDRESS CITY&STATE �r ZIP PHONE
Jc G' S_ GG / S2 7S -2/¢�
ECTIONJOB SIF /l " 2� ^t ZAL p y� �^ SEE ATTACHED SHEET)
CR. C.�7l L O .NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
TRACTOR
USE OF
BUILDING
Class of work: JV&EW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE r
cp ',IAL C0NDIT ION S:
Jr
BEDROOMS {DECKS CARPORT ❑ NOTICE
BATHROOMS (TOTAL SQ. FT.___ GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ 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 Li
SEASONAL ❑ FLOODPLA N ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lie. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be i/con rmance therewi h. MOTOR VEHICLE PERMIT
PLI TION ACCE ED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date. BY
\P AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O C'