HomeMy WebLinkAboutBLD26774 Pellet Stove - BLD Permit / Conditions - 9/21/1990 I
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED u
PERMIT NOI ' L
NAME MAILADDRESS C, C1 Y6STATE 1 PHONE
OWNER 15I 1 5 ri ��X�1 6,r U)A. Lt2(D-j
�o JOB Is TE Y1 I� "� U-C `� '
PARCEL LEGAL
NUMBER OI�- 55 MOIL( DESCR. C,� r I ►'1 wood I ►-cL-c; - 2
NAME MAIL,�IDDRESS CITY 6 TE LICENSE NO. ZIP PHONE
CONTRACTORoakl"
(D
USE
BUILDING 1,
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
WORK DESCRIBE VN S1..,. /1(1 6 D P of S
EAT
DR TOTAL MS DECKS YOR N CARPORT NOTICE
DECKSEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
HROO TOTAL SO.FT. G TAL SQ.FT. CONDITIONING.
NO.OF STORIES BASEMENT R N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA BASEk4kiqT COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. SQ.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT FIRE CE ATTACHED
SEASONAL SHORELINE DETACHED
O /GAPPROVAL
(DAVIT CONTRACTORS AFFIDAVIT
I C I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
CERTIFY
LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REFOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBR�O,V'A�LfiFRNO�M/THE BBUUI/LDDIINNG��D,/EPARTMENT. QAPPROVAL FROM THE BUILDING DEPARTMENT.
Xv'^'�+W IQ,�`�'""`�""`- DATE `l �� l� XBY _ DATE
FOR OFFICE USE ONLY
DEPARTMENT YES APPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE v
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL 1✓� %
BY CASH CK MO