HomeMy WebLinkAboutBLD12198 Air Tight Stove - BLD Application - 3/26/1982 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 3
DATE ISSUED
PERMIT NO. 1a 1 L
rLO
NAME A. BAI DRESS ! I CITY ST I �v ,_/
rL�aGt, c pG� F/ ,/fix r TO CMA4 .V ITY `J3J"C f�'
E C 518� D r �i�1.,++S J o��` N
(❑ SEE ATTACHED SHEET)
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,OT y'D J /� vRI I ND
NAMEMAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
OR 5/�j'�/"rNC� 440M,5�
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
1 A)5- t1_L
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ ATTACHED.❑ OR AIR CONDITIONING.
TOTAL SO. 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
WORK IS COMMENCED.
I certify that I am a currently registered contractor in
the State of Washington and I am aware of the Fp R OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in EPERMANENT ❑ SHORELINES ❑
conformance therewith.
AL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
Special Approvals IN OUT YES APPROVED NO
By
ZONING
Lic. No.
Date
PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT 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 BUILDING DEPT.
of the Mason Count ordinance requirements for
which this permit is iss ed and that all work done will ROAD ACCESS
in conforma c ewith. MOTOR VEHICLE PERMIT
O PLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Dat Qr((/ O � �/
PLAN ECK VALIDATION CK.. M.O. CASH
�/OFERMIT VALIDATION CK. M.O. ASH