HomeMy WebLinkAboutBLD7495 Heat Stove - BLD Application - 9/29/1980 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 4�
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL AD ESS CITY 8 STATE _ ZIP PHONE
DIRECTIONS
TO JOB SITE C OAS "�17
LEGAL CC (❑ SEE ATTACHED
DESCR. 70W41 /V ��/ RGT I n X F''5.,C
NAME MAIL ADDRESS CITY✓I<STATE LICENSE O. PHONE
CONTRACTOR .'Y - %tl v &�a 246
USE OF �/
BUILDING
Class of work: je NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE / �o
SPECIAL CONDITIONS:
BEDROOMS DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE Ll
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT El ATTACHED AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED ❑
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. ❑
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 BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be i nformance the ewith. M TOR VEHIC E ERMIT
� A LICATION C EP ED BY PLANS CHECK BY AP E F I UAN
Owner ate67 BY
CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CAS