HomeMy WebLinkAboutBLD21081 woodstove - BLD Application - 10/19/1987 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUEDAL'/
PERMITNO.:�N?/1'-)
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER '�A-imowo C 1. 40-q k son Sh $$
DIRECTIONS Lt' b -s(om
TO JOB SITE
N i
PARCEL LEGAR O 2
NUMBER DESC WQ
vet t-h/NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR iseu
USE OF
BUILDING
CLASS OF NEW _ / ADDITION ALTERATION FREAIR MOVE REMOVE
WORK ✓ V
DESCRIBE
WORK N
BEDROOMS_ DECKS t CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS � TOTAL SQ.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 SO.FT. LS4O- FIREPLACE DETACHED ✓ ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT L.," _ 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 CQNFORMANCE 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.
O NE "��-- DATE %���- X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES NO
NO DEPARTMENT YES No
BUILDING VALUATION ~
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL.
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
BY CASH CK MO TOTAL /`���