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HomeMy WebLinkAboutBLD1987 Mobile Home - BLD Permit / Conditions - 6/13/1975 Broughton, W. K., Jr. #1987 6-13-75 SW4, NW-, 16-23-1 Mobile Home ,E'�PovG r�/To RJ �.K 72. BUILDING PERMIT APPLICATION MASON COUNTY P. O. Box 400 Shelton, Washinqton 98584 DATE - �7 n o Applican t to complete numbered spaces only. PERM IT JOB ADDR ESS N n 1DE5CLEGAL / QVal �,{ 1/ I �—, (E33EE AT ACHED SHE T) y R. ,K) Va & / ";"0,,Z,3A) 4/�2/Lc) GJ�r �� ��✓�euk� �35/� OWNER MAIL ADDRESS Z,P PHONE J/Le 1,1,2 u� CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. 3 ARCHITECT OR DE51GNER MAIL ADDRESS PHONE LICENSE NO. 4 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: $ / ! ©e) PLAN CHECK FEE PERMIT FEECi SPECIAL CONDITIONS: Type of Occupancy Const. M M Group Division Size of Bldg. No. of Max. (Total)Sq. Ft. Stories Occ. Load Fire -3 Use Fire Sprinklers APPLICATION ACCEPTED BY. PLANS CHECKED BY APPROVED FOR ISSUANCE BY. Zone Zone Required ❑Ves ❑No No. of OFFSTREET PARKING SPACES: welling 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 (Specify) 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 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. SIGNATURF F CONTRACTOR OR AUTHORIZED AGENT (DATE) 1/1 /L1, J SIGNATURE OF OWNE 1/ OWN5eK BUILDER DAT ) PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. I SHELTON PRINTING CO. 1