HomeMy WebLinkAboutBLD0294 Woodstove - BLD Application - 9/11/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED 19e
NAME PERMIT NO._ O ; 4 �/
OWNER MAIL ADDRESS CITY&STATE
PHONE
DIRECTIONS
z TO JOB SITE 7 k,J-,�,C,
PARCEL
NUMBER LEGAL
zC) DESCR. �a rr7 S d�c�s
CONTRACTOR NAME MAILADDRESS
CITY&STATE LICENSE NO.
ZIP IPHONEUSE OF
BUILDINGCLASS OF
WORK ✓ NEW ADDITION ALTERATION REPAIR MOVEDESCRIBE RE
WORK
r
BEDROOMS DECKS Y OR N CARPORT
TOTAL FT. NOTICE
BATHROOMS DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
TOTAL SQ.FT. TOTAL SO.FT. CONDITIONING.
NO.OF STORIES BASEMENT Y OR N
LIVING AREA BASEMENT THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
TOTAL SO.FT. TOTAL SQ.FT. COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
- -ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT FIREPLACE
ATTACHED
SEASONAL SHORELINE
DETACHED
OWNERSAFFIDAVI
CONTRACTORS AFFIDAVIT
I CERTIFY THAT I EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LA RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS F R WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMA CE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT NEFIR OBTAINING
OBTAINING AP VAL FROM THE DING DEPARTMENT.
i APPROVAL FROM THE BUILDING DEPARTMENT.
XOW L-DATE
X BY _ DATE
DEPARTMENT APPROVED FOR OFFICE USE ONLY
YES NO DEPARTMENT APPROVED HEALTH BUILDING VALUATION
YES No
PUBLIC WORKS
PLANNING FIRE FEE
B --�
D.O.T. BUILDING BUILDING PERMIT
SPECIAL CONDITIONS PLAN CHECK
BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY PLANS y STATE SURCHARGE
APPROVED ORI E PERMIT VALIDATION
CASH CK MO TOTAL
/�6 a
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS C &STATE
ZIP PHONE
DIRECTIONS �/
TO JOB SITE /Gf.� NO �b IA E1/1�G/� 400 AIIG�`�'�e11�/C 7114AJICI
LEGAL " UScftE�27'"�P��._ F_ _.0 ;
DESCR. �-0 zo M`� Stu '�r5' C t �^q (O S—EEy�A-TTACHED SHEET) � /�v jA Lp�i4
NAME J J�j+ / I �� � �V
CONTRACTOR MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
USE OF �i J
BUILDINGdClass of work: NEW ❑ ::ITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe wor : _
DNclp� ��. .S ,k LtJ�[_L- S - Ca .vCIC� -La
�aO � aPdG Cca t � �iE C .Ss SLi� Icr �2_S
c7 ,2tx
Valuation of ork: $C�2re)'/) PLAN CHECK FEE
PERMIT FEE
SPECIAL CONDITIONS:
�i#V I £d' _ 110�,eo,K ,d eeo?�j L N
BEDROOMS {DECKS CARPORTF] Q
BATHROOMS I TOTAL SQ. FT. GARAGE �JC '76 U NOTICE
NO. OF STORIE BASEMENT El ATTACHED L_] S SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
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 FORA PERIOD OF 180 DAYS AT ANYTIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I am aware of the
ordinance requirements regulating the work for which FOR OFFICE USE ONLY
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES
Firm
SEASONAL FLOODPLAIN
By E.D. NO. S.E.P.A. L
Special Approvals IN OUT YES APPROVED NO
Lic. No._ Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the
contract or registration law RCW 18.27, and am aware FIRE MARSHAL
of the Mason County ordinance requirements for BUILDING DEPT. - R
which this permit is issued and that all work done will ROAD ACCESS //
be in conformance erewith.
MOTOR VEHICLE PERMIT
'r r Date� APPLICATION ACCEPTED BY PLANS CHEC Y APPROVED FOR ISSUANCE
7CK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH