HomeMy WebLinkAboutBLD9959 Final Woodstove - BLD Permit / Conditions - 10/19/1982 Aw
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. �l
OWNER NAME MAIL ADDRESS CITY 8 STATE
ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL
DESCR. ��vE� �,/F-� ld (❑ SEE ATTACHED SHEET)
CONTRACTOR NAME MAIL ADDRESS CITY 8 STATE
LICENSE NO. PHONE
USE OF
BUILDING
Class of work: _4-NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE
PERMIT Fqr
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑
BATHROOMS I TOTAL SO. FT. GARAGE ❑ NOTICE
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
TOTAL SQ. FT. FIREPLACE ❑ DETACHED ❑ OR AIR CONDITIONING.
CONTRACTOR AFFIDAVIT THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
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 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 ❑
E.D. NO. S.E.P.A. ElBy 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.
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith.
Q / MOTOR VEHICLE PERMIT
Owner/% .� �rj ✓ Date / `�/ APPLICATION ACCEPTED BY PLANS HECK BY APPROVED OR ISSUANCE
B
P A CHECK VALIDATION CK,. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
I
•- I
Schmidt, Arlen R
2.75-3775 #9959
9/21/82
Haven
Lake Lot 192 _
St.
Rt. 2, Box 650
Tahuya,,
Wood Stove '
Contractor: E'
Self
Wood Stove Permit
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