HomeMy WebLinkAboutBLD25725 Pellet Stove - BLD Application - 5/21/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED-5_C;2/ 4D
PERMIT NO.d JCV
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER Lltlj L' W q90 91' A hiA4 91S ' -26-06/
DIRECTIONS
TO JOB SITE r/ i E (�Ocv.f I,�CAn//' f K'_4�,�t �!�y'?f�..i -1!3?Lyi
n
NUMBER y2018 31 � �� DESCR. TPARCEL LEGAL -r N O� Swi Tr 2 O , IG3��
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR J h it�Y1 A• 3
USE OF '^
BUILDING Y o m c'
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK iremaLYuxtd5bw, 1
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.FT. GARAGE CONDITIONING.
NO.OF STORI ES BASEMENT ATTACHED 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 SQ.FT. FI REPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS AFF AVIT CONTRACTORS AFFIDAVIT
I CERTIFY TH 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
REQUIREME S 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 CONFO ANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAININ PPROVALFROMTHEBUILDINGDEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. c,
X OW R DATE X BY
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING (1 L- FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP ,���, PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY I PLANS CHECK BY I APPROVED F UA CE PERMIT VALIDATION
TOTAL
9 .� BY ASH CK MO ��