HomeMy WebLinkAboutBLD14670 Woodstove - BLD Application - 9/14/1983 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
J 7 7 PERMIT NO. 4 &-7
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
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LEGAL. (/ ` a (❑SEE ATTACHED SHEET)
DESCR
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR �r'
USE OF C 1
BUILDING iE
Class of work: ;,NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
MJM k43 'WI7bVC
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT i J NOTICE
BATHROOMS TOTAL SO. FT. GARAGE
ATTACHED I-; SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT J OR AIR CONDITIONING.
TOTAL SQ. FT.7 C FIREPLACE C'_ DETACHED
Y. 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 i_i SHORELINES I J
SEASONAL C; FLOODPLAIN IJ
Firm
E.D. NO. S.E.P.A. L!
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLANNING DEPT.
Zer
WNERS AFFIDAVIT HEALTH DEPT.
PUBLIC WORKS
I am exempt from the requirements of the FIRE MARSHAL
gistration law RCW 18.27, and am aware
on County ordinance requirements for BUILDING DEPT.
rmit is issued and that all work done will ROAD ACCESS
mance therewith. MOTOR VEHICLE PERMIT
IMAM
Y PLANS CHECK BY APPROVED FOR ISSUANCE
ODate . BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH