HomeMy WebLinkAboutBLD12762 Fire Place - BLD Application - 7/28/1982 BUILDING PERHIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 g
DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS CITY&STATE PHONE
OWNER rz,
DIRECTIONS
TO JO�B SITE Z,2 3 'f
L L / (❑ SEE ATTACHED SHEET)
D CR. r/J
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
ONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. _ GARAGE 11
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED AIR CONDITIONING.
TOTAL SQ. FT. FIREPLACE ❑ DETACHED LI
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 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 ❑
SEASONAL ❑ FLOODPLAIN ❑
Firm E.D. NO. S.E.P.A. Li
By 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 is issued and that all work done will ROAD ACCESS
Sbei conformance therewith. MOTOR VEHICLE PERMIT
AP LICATION AC E D BY PLANS CHECK BY AeP�VED FOR ISSUANCE
� ner "�-'-cz Date .
PLA CHECK VALIDATION CK. M.O. CASH V ORMIT VALIDATION C
. M.O. CASH ,