HomeMy WebLinkAboutBLD75-1697 REC ROOM - BLD Permit / Conditions - 4/10/1975 1,4A11YA a 0 0,9 / 4 S
• BUILDING PERMIT APPLICATION
MASON COLD TY
P. O. Box 400 Shelton, Washt gton 98584
DATE__
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PERMIT NO. 16f7 _ a m
Applicant to complete numbered spaces only. a
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JOB ADD E
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LEGAL ( SEE ATTACHED SHEET)
1 DESCR.
OWNER MAIL ADDRESS [�ZIP { , PNONE
A_ l� O �JCS �Q �0: \w J1 42,41002
CONTRACTOR 1Z MAIL ADDRESS PHONE LICENSE NO.
3
ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
LENDER e MAIL ADDRESS BRANCH
6
USE OF BUI DING
7
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8 Class of work: ❑NEW ❑ADDITION ®ALTERATION ❑ REPAIR ❑MOVE ❑ REMOVE
9 Describe work:
CIL
10 Change of use from
Change of use to
a�*
11 Valuation of work: $ DO a PLAN CHECK FEE PERMIT FEEQ,
SPECIAL CONDITIONS: Type of Occupancy
Const. Group Division
Size of Bldg. No.of Max.
(Total)Sq. Ft. Stories Occ. Load
Fire Use Fire Sprinklers
APPLICATION ACCEPTED BY: PLANS CHECKED BY: APP OVED FOR ISSUANCE BY'. Zone Zone Required ❑yes ❑No
-d/_ )^ i No.of OFFSTREET PARKING SPACES:
zlt!!!/// !(J Dwelling Units Covered Uncovered
N 0 T I C E Special Approv Is Required Received Not Required
ZONINC:
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- OTHER (Soecif )
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
irdinances governing this type of work will be complied with whether
oecified herein or not. The granting of a permit does not presume to
ve authority to violate or cancel the provisions of any other state or
,al law regulating construction or the performance of construction.
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'URRE'y OF ONTRACTOR OR AUTHORIZED-AGENT (DATE)
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OF O ER IF OWNER BUILDER) ATE)
X VALIDATION CK. M.O. CASH PERMIT VA JDATION cK. M.O. CASH
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