HomeMy WebLinkAboutBLD1900 Rec Room and Den Addition - BLD Application - 5/28/1975 BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washington 98584
DATE
Applicant to complete numbered spaces only. PERMIT NO. 900
JOB ADDRESS 1•
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LEGAL
1 DESCR. Q The
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1V7 /I'7r �AT/V- L/••i r e s, C.T.
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OWNER MAIL ADDRESS ZIP PHONE
z /�ourAR� E o ST R%
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CONTR:\CTOR 3 MAIL ADDRESS PHONE
LICENSE NO.
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4 ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS PHONE
LICENSE NO.
LENDER MAIL ADDRESS
6 BRANCH
USE OF BUILDING
7 L/
8 Class of work: ❑NEW Q1 ADDITION ❑ALTERATION ❑ REPAIR ❑MOVE ❑ REMOVE
9 Describe work: 14 7"lmay n Ee r 6e p/-'l `4
10 Change of use from _
Change of use to
-- I
11 Valuation of work:$
�— PLAN CHECK FEE FEE �� ��
SPECIAL CONDITIONS: Type of Occupancy
Const. Group = Division
Size of Bldg. No.of Max.
(Total)Sq. Ft.8Q() Stories Z— Occ.Load r a
Fire Use Fire Sprinklers
APPLICATION ACCEPTED BY: PLANS CHECKED BY: APPROVED FOR ISSUANCE BY: Zone —3 Zone Required ❑Ves ONO
�-- No.of
OFFSTREET PARKING SPACES:
'& I &_/ Dwelling Units Covered Uncovered
N 0 T I C E ..special Approvals Required Received Not Required
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, ZONlN6
HEATING, VENTILATING OR AIR CONDITIONING. HEALTH DEPT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION FIRE DEPT.
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC OTHER (somify)
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 4`local law regulating construction or the performance of construction. R,
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
I AT R OF OWNER ur OWNER eU ILD[R ATC
LAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION cK. M.O. CASH
)
SHELTON PRINTINO CO.