HomeMy WebLinkAboutBLD1942 ReRoof - BLD Application - 6/6/1975 7.
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BUILDING PERMIT APPLICATION
�j MASON COUNTY
P� Box 400 Shelton, Washinqtcn 98584
l I DATE
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PERMIT N0. ..a— a
Applicant ip complete numbered spaces only. a
JOB ADDR ESS U
6 �� XA1 , <
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1 DESCR. l / — �/ �/ �2 _ ;2— �2_ (E]SEE ATTACHED SHEET)
LEGAL
OW ER #.RAIL ADD'IR SS ZIP �PHONE
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CO TRACTOR MAIL ADDRESS PHONE LICENSE NO.
3ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
LENDER MAIL ADDRESS BRANCH
6
USE OF BUILDING
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8 Class of work: ❑ NEW ❑ADDITION $4ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
9 Describe work: CX�o
10 Change of use from
Change of use to (
11 Valuation of work: $ S60, 00 PLAN CHECK FEE PERMIT FEE �
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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 ❑yes ❑No
No.of
/ OFFSTREET PARKING SPACES:
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 (Soeclfy)
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.
SIG A ;�F;TcRIZED ENT _ (DATE)
SIG ATURE OF O ER '1 OWNER DU ILDER DA-M)
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
SHELTON PRINTING CO.