HomeMy WebLinkAboutBLD8770 Demo Nursing Home - BLD Permit / Conditions - 1/7/1976 Reynolds, Pat Allen #8770
1-7-76
Lots 1 thru 8 Bocks 4 & 5, Town of Allyn
Demolition of Nursing Home
BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584 l— 7 "
DATE
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Applicant to complete numbered spaces only. PERMIT N0. ��
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JOB ADDRESS
LEGAL • O (❑SEE ATTAC EE7y /
1 DESCR. �,(w/
MAIL ADDRESS ZIP PHONE
2 '
�3 .1 D 0 '7 d1A,-lt^
CONT CTOR
MAIL ADDR S PHONE LICENSE NO.
3
ARCM T CT OR DESIGNER MAIL ADDRESS PHOfE 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: '
10 Change of use from
Change of use to
11 Valuation of work:$ �,.�
PLAN CHECK FEE PERMIT FEE J
SPECIAL CONDITIONS: Type of Occupancy
Const. Group Division
Size of Bldg. No.of Max.
(Total)Sq. Ft. Stories Occ.Load
Fire Use Fire Sprinklers
A
PATOON ACCEPTED BY: PLANS CHECKED BY: APPROVED FAR I NCE BY: Zone Zone Required Oyes ONO
No.of
C- OFFSTREET PARKING SPACES:
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^F I! 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.
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- CitHER (Soecify)
TION OR WORK IS $USPENDED OR ABANDONED FOR A PERIOD OF
120 DAYS AT ANY irrME AFTER WORK IS COMMENCED.
I hereby certify that 1 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.
7-76
SIGNATURE OF CONTRACTOR OR eUIF®R .. GENT (DATE)
SIGNATURE OF OWNER I►OWNER BUILDER DATE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O.
V SHELTON PRINTING CO.