HomeMy WebLinkAboutBLD11268 Wood Stove - BLD Application - 8/21/1981 BUILDING PERMIT APPLICATION
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MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED-
PERMIT NO.
OWNER NA E MAIL ADDRESS CITY 8 ST TE ZIP PHONE
3 EM AA 0 1
DIRECTIONS t4
TO JOB SITE
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LEGAL C , _ \ _ r (❑ SEE ATTACHED SHEET)
DESCR. I�� "�-
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ 00 PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ElOR 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
certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the FOR OFFICE USE ONLY.
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
Conformance therewith. PERMANENT; SHORELINES El
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. ❑
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
con ract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
hi thi permit is issued and that all work done will ROAD ACCESS
b ,in forma rewith. MOTOR VEHICLE PERMIT
ntVION ACr
QUEPTED BY PLANS CHECK BY APPROV F IS U NCE
Ow er Date. 1 BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. JEASH