HomeMy WebLinkAboutBLD8020 Deck - BLD Application - 6/18/1975 7;1)y/<o.P, =/U/5 z
BUILDING PERMIT APPLICATION
MASON COUNTY SZZ3yq-3 C,!0} )
P. O. Box 400 Shelton, Washinaton 98584
DATE--
PERMIT N0. SD_-R'a
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Applicant to complete numbered spaces only.
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JOB ADDR ESS
LEGAL /J (E]SEE ATTACHED SHEET)
1 DESCR. /� I� � �� V ��-✓5�—�J
OWNER MAI,�DR E55 I:P'._ PHONE
2
CON RAC TO MAIL,ADDRESS PHO14E LICENSE NO.
ARCHIT CT OR D GNER MAIL ADDRESS PHONE LICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
LENDER MAIL ADDRESS BRANCH
6
USE OF BUI DING
7
8 Class of work: ❑ NEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
9 Describe work: c c �� ��✓�2 ��� �
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10 Change of use from
Change of use to
11 Valuation of work: $
PLAN CHECK FEE PERMIT FEE I
SPECIAL CONDITIONS: Type of Occupancy
Const. Group Division
Size of Bldg. C ,j No.of Max.
(Total) Sq. Ft.ti+ 55�� Stories Occ. Load
Fire Use Fire Sprinklers
APPLICATION ACCEPTED BY. PLANS CHECKED BY APP OVED FO(i IS ANCE BY Zone Zone Required Oyes ❑NO
OFFSTREET PARKING SPACES:
No.
7/ Dwellofing 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 (Soecify)
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 AUTHORIZED AGENT (DATE)
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SIGNA URE OF OWNER IF OWNER �1.1.1 (DATE)
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PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
`// SHEL-TON PRINTING CO.