HomeMy WebLinkAboutBLD8049 Carport - BLD Application - 6/24/1975 r
BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584
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Applicant to complete numbered spaces only. PERMIT
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JOB ADDRESS �y U
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1 DESCR.
OWNER MAIL ADDRESS ZIP PHONE
CONTRACTOR MAIL ADDRESS PHONE LICENSE NO.
Z 41
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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: ekA e&7- 0 G 1 f � 4f�
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10 Change of use from
Change of use to
11 Valuation of work:$
QV [Fire
N CHECK FEE PERMIT FEE
SPECIAL CONDITIONS: e of Occupancy
st. fl?.'hi1Ic Group Division
of Bldg. No.of Max.
tal)Sq. Ft. Y.T.- Stories Occ. Load
Use Fire Sprinklers
APPLICATION ACCEPTED BV: PLANS CHECKED 8V: APVE R ISSUANCE BVe Zone Required ❑Yes ❑No
nLR`7wtol of OFFSTREET PARKING SPACES:
Dwelling Units Covered Uncovered
N O T I C E Special Approvals Required Received Not Required
Z,ONINC.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING,
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-
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 UT ORIZED AGENT (DATE)
SIGNATURE OF OWNER IF OWNER BUILDER (DATE)
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
SHC:LTON PRINTING CO.