HomeMy WebLinkAboutBLD25250 Woodstove - BLD Application - 3/5/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.oI-
AM MAIL ADDRESS CITY 8 STATE ZIP PHONE
OWNER
G �._.
DIRECTIONS
TO JOB SITE p
xf ao-
PARCEL yX LEGAL n / $'
NUMBER DESCR. J�
NAME
�V �LADDRESS d R�,T T LIC10 ENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE
WORK
�)Ods 6 Of se r-
BEDROOMS- DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS----' GA GE CONDITIONING.
NO.OF ST RIES BASEM T ATTA THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL FT. FIREP ACE DET H ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERM ENT SH RELINE
SEASON L
OWNE S AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERT Y THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGIS ATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUI EMENTS FOR 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 C FORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBT ING APPROVAL FROM THE BUILDING DEPARTMENT. /�� APPROVAL FROM THE BUILDING DEPARTMENT.
NER ATE V X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES APPROVEDJO DEPARTMENT YES DEPARTMENT
BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP �L� PRE-INSPECTION
SHORELINE
WOODSTOVE rJ�O
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY AP0ROVED-*p'pRfSSU CE PERMIT VALIDATION -�
�• � TOTAL
3 " J � BY - CASH CK MO