HomeMy WebLinkAboutBLD0458 Woodstove - BLD Application - 10/28/1986 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584 c
426-5593 DATE ISSUED o
PERMIT NO.-
OWNER y,4ME dd MAILADDRESS CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE ,tom sL2 3LEGAL
DSCR. I7 p[ - � �r �o /Y �/� k5-c:!/
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR T
USE OF
BUILDING `
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTALSQ.FT. GARAGE CONDITIONING.
NO.OF STORIES 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 LACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS FIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY HAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT 1 AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTR ION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIR ENTS 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 CO FORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTA ING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
a
OWNE ATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT Y SPPROVEDJO DEPARTMENT YEAPPROVED,O BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE Of BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP -3 PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY I PLAN Sc K13Y APPROVE rNCE PERMIT VALIDATION
� G�6�w� BY�pJ' ° CASH CK MO TOTAL
i
MASON COUNTY
P.O. BOX 186 Shelton,Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT—Complete ALL items. Mark boxes where applicable.
Name Mailing address—Number,street,city,and State Zip code Tel.No.
Owner
2. t G 4r o
Contractor
O p
The owner of this building and the undersigned agree to conform to all applicable laws of Mason County and State of Washington
Signal re of applican Address Application date
l'm, 5 e t)- S�'e/7 W/ 76
LEGAL DESCRIP ON
Location
Of
Building S C
NO. PLUMBING FIXTURES FEE
WATER CLOSETS Q Z
BASINS AJ O
BATH TUBS y
SHOWERS G 0
WATER HEATERS C
AUTO.WASHERS
SINKS C
FLOOR DRAINS
L�
DRINKING FOUNTAINS
LAUNDRY TRAYS
a e
Connect to City Sewer
DISH WASHER
DISPOSAL
URINAL
(Show Street Names & Property Lines)
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT SKETCH IN SEPTIC TANK 3 DRAIN FIELD LOCATION OR SUBMIT
ON OTHER SKETCH.
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Approved by Permit fee Date pemit issued Permit number Receipt No.
CHRISTMASTOWN PRINTING