HomeMy WebLinkAboutBLD20932 Woodstove and Chimney - BLD Application - 9/21/1987 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 9' ���
DATEISSUED /
PERMIT NO. �
OWNER NAME MAIL ADDRESS CITY 3 STATE ZIP PHONE
G(J/SE NE 2/.1-1 QZyg �t0 a eTe aJ jVA AZ _
DIRECTIONS
TO JOB SITE &V A_11? / T FN10 04 —7_14 i9/lE
LEGAL �+ �c (❑SEE ATTACHED S EET)
DESCR. j,)/r?30.S-.35� ba000 a� .� r /!�/�• a.�
NAME MAIL ADDRESS CITY 6 STATE LICENSE N . PHONE
CONTRACTOR
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USE OF �J3GG
BUILDING
Class of work: ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
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Valuation of work: $ PLAN CHECK FEE PERMIT FEE
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SPECIAL C DITIONS:
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BEDROOM DECKS CARPORT❑ NOT I C E
BATHRO S TOTAL S0. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. LFRS BASEMENT ❑ OR AIR CONDITIONING.
TOTA 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
y that I am a currently registered contractor in WORK IS COMMENCED.
ate of Washington and I the
aware of the FOR OFFICE USE ONLY
ce requirements regulating the work for whichmit is issued and all work done will be in
ance therewith. PERMANENT ❑ SHORELINES ❑
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. a)aW_.2A0X /lad 027- Date _?——Z7 X7 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 BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date, BY
PLAN CHECK VALIDATION CK; M.O. CASH PERMIT VALIDATION CK. M.O. CASH
CHRISTMASTOWN PRINTING