HomeMy WebLinkAboutBLD29638 Wood Stove - BLD Application - 12/3/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
-1 1 -3 PERMIT NO.,;�?CC
NAME MAIL ADDRESS_ CITY&STATE ZIP PHONE
OWNER � , 7,f46el� 336
DIRECTIONS _
TO JOB SITE f / /' ell
Ae'vier 0, 0,�®sly` e ;-V Vewl—
PARCEL _ LEGAL
NUMBER �� �I DESCR.
NAME MAIL ADDRESS CITY R STATE ZIP PHONE LICENSE NO.
CONTRACTOR �G
USE OF
BUILDING
CLASS OF NEW C----- ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK lg .
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE U CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
DECKS SgFt BATHROOMS SEASONAL RES.❑ ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED 0 DETACHED
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 OWNE f 1,411 -' DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE --
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED F R ISSUANCE PERMIT VALIDATION
IBY l CASH CK MO TOTAL
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS C11 3 STATE ZIP PHONE
OWNER I CJ-j qj �q a 5T
DIREC 1CNS my yes 3�7
TO JOB SITE k �� lwi a/Y
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PAR EL II a.LEGAL I '
NUMaER1 '-1 91 000321 DEsc l,a0 1 /,)
Indicate below: O Property lines and dimensions.
O Easements and roads.
O Septic, drainfield and reserve area, or sewer.
O Septic tank and drainfield setback distances from foundations.
O Location of proposed construction on property.
O Building & septic system setback distances from all property lines & easements.
Indicate North O Well and water line.
O Saltwater, lakes, rivers, streams, wetlands, drainage.
In Circle O Attach copy of septic system "as built" or septic permit-approval.
,�Q. Indicate topography profile of property and structure on reverse side.
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I/we certify that'he-,reposed construction will conform to the dimensions and uses shown above and;hat no changes will be made without first obtaining approval.
SIGVA7URE OF OwNER(Sl OR AUTHORIZED RE?RESENTATIVE
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