HomeMy WebLinkAboutBLD23033 Fireplace Insert - BLD Application - 11/15/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 _
427-9670 DATE ISSUED / -Zl
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PERMIT NO.C1Ln\3GJ%5
M D S CITY BSTAT // ZIP ONE
OWNER 'l v� � _E S 5 JL9 -�
DIRECTIONS''
TO JOB SITE
il.✓ !{� L 1. � �.�� t _ �,. C `/LAY/J �
PARCEL LEGAL
N U M B S - DESCR. ^t I C L (, 2
NAME M ADDRESS CITY&STATE LICENSE NO. UP PHON
CONTRACTOR S" al _ l
USE OF
BUILDING � G
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
1 CE"18.27,,
AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGRCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQ WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
XODATE j� X BY DATE-
�l
FOR OFFICE USE ONLY
D RTMENT YES APPROVEDJO DEPARTMENT YESPPROVEDIO BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
W 0O DSTOV
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
BY CASH CK MO r'"
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
Courthouse Annex I N. Fourth & W. Cedar
P.O. Box 186 Shelton, Washington 98584
(206) 427-9670
building environmental health maintenance landfill parks&recreation fair/convention center planning sewer&water CHECKLIST FOR PROPOSED CONSTRUCTION
No yes
C ] [ ] Within 2a feet of designated shoreline or wetland
[\/] C ] Proposed construction on/over/in wetland
C ] C ] Proposed construction within floodplain
[✓] [ ] Commercial Development (Parking Standards , Sign
Ordinance, Public Works Review, other applicable
agencies )
C /] [ ] Mobile Home and/or R.V. Park
What Type Of Construction Is Being Proposed?
[r' J C J Exempt from building permit application
C J C\/] Exempt from S.E .P.A. process (WAC 197-11-305,
WAC 197-11-eOO )
[ ] [ ] Meet all requirements (Which section ( s ) of
S.M P. does proposed construction pertain to?
l,41161Lzw. .,a of 6, ,`4z� )
[V ] [ ' ] Variance or Conditional Use Permit required
C ] C ✓] Exempt from Shoreline Substantial Development
Permit process (WAC 173-14-040 )
[ J C ✓] Exempt from Substantial Development but within
Army Corp.jurisdiction (WAC 173-14-115 )
Printed 3/69 -�
Date Initials
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