Loading...
HomeMy WebLinkAboutBLD11654 Fireplace - BLD Permit / Conditions - 10/28/1981 BUILDINGPERM IT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 p J 426-5593 .O/ DATE ISSUED D.� - PERMIT NO. NAME - MAIL ADDRESS' CITY&STATE ZIP PHONE OWNER ' RC-;'U �{ C .0 cv-Q') 3 DIRECTIONS TO JOB-SITE Oc, A e LEGAL /' / - l _-( 'SEE ATTACHEDSHEET) -NAMt MAIL ADDRESS CITY 8 STATE LICENSE NO. ` PHONE CONTRACTOR - � USE OF /'"` .. BUILDING l.T I� ZL30 4 jcL 14,-L rt n Lt,�)C JV'6 KZXfi (R- Class of work: ❑ NEW :ADOITION - ❑ ALTERATION, " ❑ REPAIR ❑ MOVE ❑ REMOVE- ; Describe work: Fl� C. ivv I Y1C. e Valuation of work.: $ 3 © ®� ' PLAN CHECK FEE - PE MIT F*.� SPECIAL CONDITIONS,: - - - BEDROOMS IDECKS T' CARPORT El - - NOTICE BATHROOMS TOTAL,SO. F GARAGE ❑ - ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR ,PLUMBI i G, 'HEATING, VENTILATING + NO. OF STORIES BASEMENT ❑ - _ OR AIR CONDITIONING. ❑ DETACHED ❑ - - TOTAL'So. FT. FIREPLACE THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR- CONTRACTOR AFFIDAVIT. , [ZED IS NOT COMMENCED WITHIN 180DAYS,OR IFCONSTRUCTION ORWORKIS SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME AFTER I certify that I.am a currently;registered contractor in - WORK IS COMMENCED. the State of Washington and I am: aware of the p .,1 ordinance requirements regulating the work-for which FOR OFFICE. Us ONLY the permit is issued and all work done will.. be in conformance therewith. PERMANENT ❑- SHORELINES D SEASONAL - - FL60DPLAIN ❑ Firm E.D. NO. " S.E.P.A. ❑ BY . . - Special Approvals IN OUT YES APPROVED NO . Li No. Date ZONING - - PLANNING DEPT. - HEALTH.DEPT. OWNERS AFFIDAVIT- PUBLIC WORKS -.I certify that I am exenipl from the requirements of the FIRE MARSHAL j contract or registration law RCW 18 27, and am aware If of the BUILDING DEPT. _' Mason County ordinance requirements for - ,which.this permit is issued and that all work done will. ROAD ACCESS - be in conformance therewith. , ' r - - MOTOR VEHICLE PERMIT y 1 A LIGATION A CEPTED BY : PLANS CHECK BY APPROY_FFDAOR ISSUANCE J . I/ 01 N CHECK VALIDATION' CK. M.O. CASH ERMIT,VALIDATION CK�'' . M.O. CASH - J Mirguet, Eugene H. #11654 s . . 226-0743 (Renton) 10/28/81 ; Tract 3, of NE, 14-20=2 East 200 Harstine Island Road South. Free Standing Fireplace Contractor: Self i $-- Wood Stove Permit c.C/G q r 1 \