HomeMy WebLinkAboutBLD80-9183 - BLD Permit / Conditions - 12/10/1980 #9183
Clevenger; David L. 12-10-80
Lot 6, Parkwood
Rt. 10, Box 622
Wood Stove & Chimney
Blazer Wood Stove
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BUILDING PERMIT APPLICATION
MASON COUNrrY
Box 186 Shelton Washington ton 98584 9
426-5593
D ATE ISSUED
PERMIT NO. i
NAME MAIL ADDRESS CITY&STA E ZIP PHONE
OWNER
vio Z. CfErvc� cam- n,�.je 8 �z �i � G�iZ% ��-�y yap z 7/
DIRECTIONS 1 �+
TO JOB SITE D r �'1 �J� LcJd*pQ S�CrJv-0 �T-� l5l"%A�o �1l/Gl
LEGAL j` (❑ SEE ATTACHED SHEE
DESCR.
NAME MAIL ADDRESS CITY&ST ATE LICENSE NO. PHONE
CONTRACTOR ',
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ OVE ❑ REMOVE
Describe work:
Valuation of work: $ -- PLAN CHECK FEE PERMIT FEE ,
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
SEPARATE PEF WITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ ATTACHED ❑ OR AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE GY DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT C014MENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS
SUSPENDED O 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
F F I^E USE ONLY
ordinance requirements regulating the work for which (,r
the permit is issued and all work done will be in
conformance therewith. PERMANENT ❑ SHORELINES ❑
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. L l
BY Special Approvalsi IN OUT YES APPROVED NO
Lic. No.— Date ZONING
PLANNING DEFT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORK
/be
rtify that I am exempt from the requirements of the FIRE MARSHAL
tract or registration law RCW 18.27, and am aware BUILDING DEP .
the Mason County ordinance requirements forch this permit is issued and that all work done will R AD AC ESS
in confor a e herewith. OTOR�AHICL P RMIT
PP ATION C PTE BY PLANS CHECK BY P D FOR SU CE
Owner Date. BY
AN CHECK VALIDATION CK.. M.O. CASH PERMIT VALIDATION CK. M.O. CASH