HomeMy WebLinkAboutBLD9722 Wood Stove - BLD Application - 12/24/1979 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATEISSUEDILS7, Z(—/ obz /0 PERMIT NO.
OWNER NAME MAIL ADD CITY&STATE ZIP PHONE
S � . . i - '18o
DIRECTIOT ;2, ALLIi✓ c>A) d4vX' � 47—
TO JOB SITE L — av ,f eA)
LEGAL (❑ SEE ATTACHED SHEET)
DESCR.
CONTRACTOR NAME MAIL A DRESS CITY&STATE LICENSE NO. PHONE
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
VS- v 1iZ L Lv CC'4!) P-)L UijLJIC '—k 11--
Valuation of work: $ PLAN CHECK FEE PERMIT FEE�r
SPECIAL CONDITIONS:
LEE
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED L' 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 AUTHORIZED
CONTRACTOR AFFIDAVIT 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
I certify that I am a currently registered contractor In WORK IS COMMENCED.
the State ofWashington and I aware of the FOR OFFICE USE ONLY
ordinance requirements
the regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT-PERMANENT -i SHORELINES I i
SEASONAL L:1 FLOODPLAIN I
Firm
E.D. NO. S.E.P.A. L'
By 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 FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT. / yC
which this permit is issued and that all work done will ROAD ACCESS
be in con ance therewith. MOTOR VEHICLE PERMIT
j APPLICATION ACCEPTED BY
a PLAN$�IECK BY APPROVED FOR ISSUANCE
Owner �' ate_ BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. . M.O. CASH