HomeMy WebLinkAboutBLD8168 Garage and Storage - BLD Application - 7/15/1975 BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584
O
DATE
Applicant to complete numbered spaces only. �I �U/ �C�'l�v v PERMIT
JOB ADDR ESS
LEGAL (X.E I ATTACHED SHEET)
1 DESCR.
OWNER MAIL ADDRESS 71P CI 6X PHONE
- _ v
CONTRACTOR ( MAIL AD RESS PHONE LICENSE NO.
3 I
ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO.
4 Ia rA
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: $
'500 . C, PLAN CHECK FEE PERMIT FEE
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. APPROVED FOR;ISSUANCE BY. Zone Zone Required Dyes ❑No
�{ No. of OFFSTREET PARKING SPACES:
�-C L ,+.�..L.✓ Z/ Dwelling Units Covered Uncovered
N 0 T I C E Special Approvals Required Received Not Required
ZONINC.
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- OTHER fSoecify)
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.
SIGN TUR OF CON TRAC /OR AUTHORIZED EHT (DATE)
SIGNATURE OF OWNER IF OWNER BU OER (DATE)
Pt,AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
�// S-i-TON PRINTING CO.
EP-:57' HALF of T14C EP15'r HA-_F--nF�- THE
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