HomeMy WebLinkAboutBLD16207 Woodstove - BLD Application - 10/2/1984 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
s�w4 40 0 Why'✓ PERMIT NO. /6c>?0 7
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
Carol Ellis NL 3671 N Shore Rd Belf air WA 98528 275-5256
DIRECTIONS
TO JOB SITE N Ohore Rd
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. 1-22-2 Tract 12 NWI of NW f
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR Dale Cunninggam P.O. Box 1015 Belfair WA CHEAPH*19905 275-2826
USE OF
BUILDING residence
Class of work: ❑ NEW ❑ ADDITION TION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: woodstovOinstallation
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SO. FT. GARAGE ❑
ATTACHED iJ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING. VENTILATING
NO. OF STORIES BASEMENT [I ATTACHED AIR CONDITIONING.
TOTAL SQ. FIREPLACE C.] 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 ertify that I am a currently registered contractor in WORK IS COMMENCED.
e State of Washington and I aware of the FOR OFFICE USE ONLY
rdi ul ----- u the work for which
e p is issued and all work will be in
conformance therewith. PERMANENT i. SHORELINES I-
Cheap eat SEASONAL 1 i FLOODPLAIN i
E.D. NO. S.E.P.A. �
B Special Approvals IN OUT
YES APPROVED NO
Lic. No.�hllHl 5 Date 0 1G 1 84 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 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
ICA N ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Owner Date . BY
`LAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH