HomeMy WebLinkAboutBLD0400 Fire Place Insert - BLD Permit / Conditions - 7/9/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
,a rl _y; _CWg6 DEPARTMENT Of GENERAL SERVICES
426 W.CEDAR/P.O.BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISS ED 7 _9
PERMIT NO 3"D0
NAME MAIL RES CITY&STATE ZIP PHONE — �D
OWNER l
DIRECTIONS £ (�(� 00
TO JOB SITE
PARCEL LEGAL S
NUMBER DESCR.
NAMETa MAILADDRESS CITY 6j�T �_1��- �l NgNE �LqH} n I
CONTRACTOR S 7(f/ !^'
USE OF
BUILDING
CLASSOF NEW ADDITION A/ ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE e
WORK
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, H TING, VENTILATING OR AIR
RESIDENCE _Sq Ft STORIES SHOREUNEO CONDITIONING.
BASEMENT SgPt BEDROOMS PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSI RUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION R WORK IS SUSPENDED OR
DECKS SgFt BATHROOMS_ SEASONAL RES.O ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED O DETACHED❑
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS FORWHICH THISPERMIT IS ISSUEDANDTHAT ALLWORK DONEWILLSE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OffTAININ,%AVPFQ,VAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OW X BY DATE
FOR OFFICE USE ONLY
APPROVED DEPARTMENT APPROVE NO BUILDING VALUATION
DEPARTMENT YES No YE
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING V PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
IWOODSTOVE
UMBING
ECHANICAL
ATE BUILDING FEE
APPLICATION ACCEPTED BY PLANSCHECKBY APPROVED FOR ISSUANCE PERMIT VALIDATION . TOTAL
MO
gy CASH CK