HomeMy WebLinkAboutBLD5034 Fireplace Final - BLD Permit / Conditions - 12/22/1983 #15034
STATE OF WASHINGTON 12-20-83
DEPARTMENT OF FISHERIES
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16-21-4, NW-4,SW%
North on Highway 101, left on Skokomish Valley Road, left
on Deyette Road
Contractor
Self 753-6600
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BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 _ Z
DATE ISSUED�� —
PERMIT NO. c
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER 6VO -7-S.3CoC
DIRECTIONS
TO JOB SITE '¢� �• v
LEGAL ❑ SEE ATTACHED SHEET)
DESCR. � �' '-CA AI Lt1C_ ;01 —
NAME MAIL ADDRESS l CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: ,
Valuation of work: Srf PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS {DECKS CARPORT ❑ NOTICE
BATHROOMS (TOTAL SQ. FT. GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR 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 USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT ❑ SHORELINES ❑
SEASONAL (( FLOODPLAIN Ll
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
I ertify that I am exempt from the requirements of the FIRE MARSHAL
ontract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit is issued and that all work done will ROAD ACCESS
be i c forma therewith. . MOTOR VEHICLE PERMIT
OWner Date 1 P CAT( ., ACCE ED..�Y PLANS CHECK BY APPROVED FOR ISSf
BY
PLAN CHECK VALIDATION CK.. M.O. CASH PERMIT VALIDATION CK. M.O. CA