HomeMy WebLinkAboutBLD14809 Fireplace Insert - BLD Application - 10/14/1983 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593 L, 3
DATE ISSUED
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
S IR I
DIRECTIONS
TO JOB SITE /Isji Le��` �,Iv�v s�risS�•�, f ke,4r t!/ou leA�' � S"
DESCR. G v � L� LK 3 /�1�SS���tJ �pLEGAL � � Q s —(❑ FEAT HED SHEET)
NAME MAIL ADDRESS '-CI`TY 6 STATE �LII`CENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE,(j 0-0
—
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT ❑ NOTICE
BATHROOMS TOTAL SQ. FT. GARAGE []
ATTACHED C SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT L OR AIR CONDITIONING.
TOTAL SO. FT. FIREPLACE ❑ DETACHED
Ll 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
SEASONAL ❑ FLOODPLAIN I
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 t t I am exempt from the requirements of the FIRE MARSHAL
contrac or registration law RCW 18.27, and am aware BUILDING DEPT.
of th Mason County ordinance requirements for
whi this permit is issued and that all work done will ROAD ACCESS
be n conformance the ith. MOTOR VEHICLE PERMIT
/ /f' PP (CATION ACCE TED BY PLANS CHECK BY APPROV R ISSUANCE
Owner —___ Date. (/ i
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH