HomeMy WebLinkAboutBLD9967 Woodstove - BLD Application - 10/5/1982 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 DATE ISSUED S -��-
C
PERMIT NO.
CITY&STATE ZIP PHONE
NAME MAIL ADDRESS r�.( _i/Q�,��
OWNER u T
DIRECTIONS
TO JOB SITE l:� i��L El-'
(❑ SEE TTACHED SH T)
DELEGS E , �> IV k 9-
` ��MAIL A DRESS CITY&STATE LICENSE NO. PHONE
NAME
CONTRACTOR F C�(L�11nYG� �l
I MOO
USE OF
BUILDING
Class of work: ❑ NEW it ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
PLAN CHECK FEE PERMIT FEE �g
Valuation of work: $ J
SPECIAL CONDITIONS:
BEDROOMS__ I DECKS. —_ CARPORT CI NOTICE
BATHROOMS_--- TOTAL SQ. FT._—_ GARAGE i l SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES__ BASEMENT , .
ATTACHED l- OR AIR CONDITIONING.
DETACHED C
TOTAL SO. FT._-- FIREPLACE " THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR
,TOTAL 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
WORK IS COMMENCED.
I certify that I am a currently registered contractor in
the State of Washington and I am aware of the F p R OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be In PERMANENT SHORELINES
conformance therewith.
SEASONAL L FLOODPLAIN C:
Firm E.D. NO. S.E.P.A. C
APPROVED
Special Approvals IN OUT YES NO
By
Date ZONING
Lic. No.— PLANNING DEPT.
HEALTH DEPT.
OWNERS AFFIDAVIT 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
b n conformance herewith. MOTOR VEHICLE PERMIT
�� �� �a /�' � APPLICATION ACCEPTED BY P�,A�K� APPROVED FOR ISSUANCE
Owner - -Date .( 6yj ((jj�fiI
CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH