HomeMy WebLinkAboutBLD0615 Stove Insert - BLD Application - 3/8/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO. 12' G -5—
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER a �� S w .n PC) 0 8e ea i r- AJ ui '7 "a S 7513J-7_3
DIRECTIONS
TO JOB SITE
sad'
PARCEL LEGAL
NUMBER la-39/136ve00 IDESCR. SGCJ
AME f MAIL ADDRESS/ CITY&STATE LICENSE NO. / ZIP L PHONE
CONTRACTOR 't a G 'rGp�gcC Si1v 0 S� w C�O�SZ 377-�0�
USE OF
BUILDING
CLASSOF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓ Ir
DESCRIBE ll
WORK J »,s&-i a an SerL ,SkoVPi •- 1/ rnsr odeJ- 1�+lSyrr
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. FIREPLACE iNs ert DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS 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 CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X NER DATE 3' `li Sri X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES
PPROVENo DEPARTMENT YESPPROVENO BUILDING VALUATION -
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING ✓ PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP A PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATIONACCEPTEDBY PLANSC BY , APPROpV F RIS UANCE PERMIT VALIDATION
� t�` BY C CASH CK MO TOTAL V//