HomeMy WebLinkAboutBLD8082 Patio - BLD Application - 7/1/1975 �c )/'0'
BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584 CC_
DATE /
PERMIT
Applicant to complete numbered spaces only.3 2Z32-7 9(�l,i — U
JOB ADDR ES55 1
(A)10 A) (k-1/1SLEGAL �I
1 DESCR. O /� 2 of / —]SEE ATTACHED SHEET)
OWNER v V /MMAAIIL/�ADDRESS ZIP 7C PHONE
Z Ll �t/ d a /
CONTRACTOR MAIL ADDRESr
201,6 PHONE LICENSE HO.
ARCHITEC OR DESIGNER MAIL ADDRESS PHONE LICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
LENDER MAIL ADDRESS BRANCH ,
6
USE OF UILDING
- v
8 Class of work: CQ NEW Q ADDITION ❑ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
9 Describe work:
10 Change of use from
Change of use to
11 Valuation of work: $
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
APPLI ON ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Zone Zone Required ❑Yes ONO
No. of OFFSTREET PARKING SPACES:
l-� Dwelling Units Covered Uncovered
N O 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 lSoeclfy)
TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF
120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
hereby certify that I have read and examined this appli:ation and
know the same to be true and correct. All provisions of laws and
ordinances governing this type of work will be complied wth whether
specified herein or not. The granting of a permit does not presume to
give authority to violate or cancel the provisions of any oiler state or
local law regulating construction or the performance of construction.
t
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
r
SIGNATURE OF OWNER IF OWNER BUILDER DATE)
PLAN CHECK VALIDATION CK. M.�• CASH PERMIT VALIDATION CK- M.O. CASH
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SHELTON PRINTING CO.
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