HomeMy WebLinkAboutBLD8185 Bulkhead - BLD Application - 7/21/1975 BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584 _
DATE TV ���L7S Z
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PERMIT NO.
Applicant to complete numbered spaces only.
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JOB ADDR ESS U
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LEGAL • NEE ATTACHED SHEET)
1 DESC R. � /��:��• � � d
OWNER MAIL ADDRESS ZIP PHONE rVC �R
23 P.O. SOU .2 ► G. v_1, W.� . C �
0y-o Oo-a 1 4 F S. t.s.i, )7 G.�G — S'►3 3 7_G _ P
CONTRACTOR MAIL ADDRESS PHONE LICENSE NO.
3 _ L v--) l► tI III I'ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO. O�
5
LENDER MAIL ADDRESS BRANCH
6
USE OF BUILDING
7
8 Class of work: 'NEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
9 Describe work: CU,J G 2t Tt plr/O' C; C?cl STi,a G-
L,l_.
10 Change of use from
Change of use to
11 Valuation of work: $ �, 1DrQ V PLAN CHECK FEE PERMIT FEE co
SPECIAL CONDITIONS: Q 0 'l - Type of Occupancy
IS-1 S SS e' M M• C-Al - - Const. Group Division
T-toAt. - a `-7S— G ru*rCt: a k1s'rt1v 6 Size of Bldg. No.of Max.
if 40A-3>. (Total)Sq. Ft. Stories Occ. Load
Fire Use Fire Sprinklers
APPLICATION ACCEPTED BY. PLANS CHECKED BY APPROVED FOR ISSUANCE BY. Zone Zone Required ❑Yes ENO
[HEALTH
OFFSTREET PARKING SPACES:
I l 1•�-� ` ng Units Covered Uncovered
N 0 T I C E al Approvals Required Received Not Required
NC.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING,
HEATING, VENTILATING OR AIR CONDITIONING. DEPT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION FIRE DEPT.
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC- OTHER (Soeclfy) s
TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF CaAi/t1.S( LJ�
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 AUTHORIZED AGENT (DATE)
YgLZ(�;;_ '7 f i 7_T
SIGNAT OF OWNER IF OWNER BUILDER ATE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION i M.O. CASH
SN LT C��I PRfvTING CO