HomeMy WebLinkAboutBLD1555 SFR - BLD Application - 2/13/1975 r
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BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584
0 C
DATE 1- Z ;
PERMIT NO. 5-SZ
Applicant to complete numbered spaces only. u
JOB ADDRESS
EE
DESCR. .G fJ ,Q. q Q �L_ �/✓C I"�/•/ (WSfN TT� O�.E
OWNER MAIL ADDRESS ZIP PHONE
2 `Se_Uq h7`' c .a_ e_
CONTRACTOR I MAIL ADDRESS PHONE LICENSE NO.
s 4-;�3_tq /3 ��
ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
LENDER MAIL ADDRESS BRANCH
6
USE Of BUILDING
7
8 Class of work: ,NEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑MOVE ❑ REMOVE
9 Describe work: Ye w Res,
10 Change of use from
Change of use to
11 Valuation Of Work:$ 7 Q 7 PLAN CHECK FEE 1s PERMIT FEE 8'V E-_
SPECIAL CONDITIONS: Type of Occupancy T
Const. e � Group 1 Division
Size of Bldg. _ No.of / Max.
(Total)Sq. Ft.22J` w Stories Occ. Load
Fire Use Fire Sprinklers
APPLICATION ACCEPTED BY: PLANS CHECKED BY: APPROVED FOR ISSUANCE BY: Zone Zone Required []yes ONO
No.of OFFSTREET PARKING SPACES:
Dwelling Units Covered Uncovered
N 0 T I C E ,Special Approvals Required Received Not Required
ZONING
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEALTH DEPT. ✓e�o(
HEATING, VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION FIRE DEPT.
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC OTHER (Soeeify)
TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF
120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
I hereby certify that I have read and examined this application and
know the same to be true and correct. All provisions of laws and
ordinances governing this type of work will be complied with whether
specified herein or not. The granting of a permit does not presume to
give authority to violate or cancel the provisions of any other state or
local law regulating construction or the performance of construction.
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
f
(GNAT F OWN 1► NCR DER DATE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
SHELTON PRINTING CO.