HomeMy WebLinkAboutBLD0457 Woodstove - BLD Application - 10/21/1986 • BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED_1�
PERMIT NO. Q Ly
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHQGIE
DIRECTIONS
TO JOB SITE
LEGAL v s n � (❑ SEE ATTACHED SHEET)
DESCR. {✓�,''
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE
CONTRACTOR Sam� � �-
USE OF
BUILDING V
Class of work: )i< NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work: _
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
oD
SPECIAL CONDITIONS: I,
BEDROOMS ECKS CARPORT i t NOTICE
BATHROOMS__ TOTAL SO. FT. GARAGE I 1
ATTACHED L SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE>< DETACHED L;
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 c/rtify that I am a currently registered contractor in WORK IS COMMENCED.
th State of Washington and I the
aware of the FOR OFFICE USE ONLY
o dinance requirements regulating the work for which
he permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES
SEASONAL I i FLOODPLAIN i i
Fir
E.D. NO. S.E.P.A. I
B 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 ,6
BUILDING DEPT.
of the Mason County ordinance requirements for
lben
s permit is i yednd that all work done will ROAD ACCESS
nform ce th . MOTOR VEHICLE PERMIT
APPLICATION ACCEPTED BY PLAN ECK BY APPROVED FOR ISSUANCE
Owner Date. �S �/ BY p
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH