HomeMy WebLinkAboutBLD11005 Fireplace Insert - BLD Permit / Conditions - 7/14/1981 p ,3 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
} DATE ISSUED
PERMIT NO.
OWNER p NAME � MAIL ADDRESS CITY&STATE ZIP PHONE
�T X 73'l3 .J"��'!%o•�/ 1✓rgSle. 98.�e3 �rtd f�Y�'
DIRECTIONS
TO JOB SITE 4PC�C
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. %dW,v�t,id Zo ,S'�c. 3" ,�.Q�cf 3¢J i.P.�c 6
NAME MAIL ADDRESS CITY S STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
roscribe work:
-n-jrPm t FooplAeir are oErer
Valuation of work: $ 00 PLAN CHECK FEE PERMIT FEE � 0
6 ®o
SPECIAL CONDITIONS:
BEDROOMS- `DECKS CARPORT ❑ NOTICE
BATHROOMS- (TOTAL SQ. FT. GARAGE ❑
ATTACHED [I OR
PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT [I ATTACHED AIR CONDITIONING.
TOTAL SQ. 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
I certify that I am a currently registered Contractor In WORK IS COMMENCED.
the State of Washington and I the
aware of the FOR OFFICE U E ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES
SEASONAL FLOODPL N ❑
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
1 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
�k PLICA ION�4,CCE D BY LANS CHECK BY APPI
Ow er ��! . /tea Date,Z�� BY
'LAN CHECK VALIDATION CK,. M.O. CASH PERMIT VALIDATIOR CK. M.
t.� v
WHITE, Bile #11005
Rt- 4,"8o:k 375B, Shelton 07-14-81
Johns Creek, 5 acre tracts, 20-5-3, Tract G
Fireplace Insert
Contractor - Self
$ -0- Wood Stove Permit
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