HomeMy WebLinkAboutBLD84-16113 - BLD Permit / Conditions - 9/13/1984 MANSFIELD, Roger E. #16113
9-13-84
Cherry Park, Lot 4
E 4 Cherry Park
Shelton 98584 426-7071
Contractor
None listed
Woodstove
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BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 C` tJ
DATE ISSUED -/&
PERMIT NO. / 6 113
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
[.
DIRECTIONS
TO JOB SITE X
LEGAL n n (❑ SEE ATTACHED SHEET)
DESCR. G ,0 w a e c cC C' "i e�a
CONTRACTOR NAME MAILADDRESS CITY&STATE LICENSE NO. PIHMNE
USE OF
BUILDING
Class of work: NEW ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS _. {DECKS _ CARPORT ❑ NOTICE
BATHROOMS I TOTAL SQ. FT. GARAGE
ATTACHED i-1 SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE f_1 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 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 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 I l
SEASONAL C FLOODPLAIN
Firm E.D. N0. S.E.P.A.
By V Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
OWNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for BUILDING DEPT.
which this permit's issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
f APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
wn O r e- r ate . / BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH