HomeMy WebLinkAboutBLD1663 - BLD Application - 3/31/1975 BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584
DATE 6-317- - Z o
m
PERMIT NO. �� A
Applicant to complete numbered spaces only. u
u
JOB ADDRESS
LEGAL ` I ( E ATTACHED SHEET❑9 E
1 DESC R.
OWNER i `.'MAIL ADDRE S ZIP ONE
CONTRACTOR MAIL ADDRESS PHONE LICENSE NO.
ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5 Ile- 7 L- „
LENDER MAIL ADDRESS BRANCH
USE OF BUILDING
7 2 7C
8 Class of work: ❑NEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑MOVE ❑ REMOVE
9 Describe work:
1 10 Change of use from
Change of use to
11 Valuation of work: $ Tj Coe, PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS: Type of 9 Occupancy
Division
Const. / Group
Size of Bldg. /O>C No.of Max.
(Total)Sq. Ft. �� Stories Occ. Load
Fire Use Fire Sprinklers
APPLICATION ACCEPTED BY: PLANS CHECKED BY: APPROVED FOR ISS AJy NCE BV: Zone Zone Required Dyes []No
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. ✓ r- J` `
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 O'rHER (Specify)
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,11ONTRACTOR OR T RIZED AG EN (DATE)
( / R
I6 ATURE OF OWNER IF OW NEW BUILDER DATE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
SHELTON PRINTING CO.