HomeMy WebLinkAboutBLD4914 Pump House - BLD Application - 9/9/1976 y BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 4 Shelton, Washington 98584
?? I p DATE-9��7 F
/a J-7, PERMIT NO. 9/
Applicant to complete numbered spaces only.
JOB ADDRESS ry(�
LEGAL
1 DESCR. ✓ / ( SEE ATTAHED SHEET)
OWNER _/ MAILliDDIRESS ZIP PHONE
CONTRACTOR MAIL ADDRESS PN ONE LICENSE NO.
ARCHITECT OR DESIGNER MAIL ADDRESS PH NE LICENSE NO.
4 � Ile
ENGINEER f-_ MAIL ADDRESS PHONE LICENSE NO. A '
5U1 \
�!
LENDER MAIL ADDRESS BRANCH
USE OF BUILDIN
te zo 4�f Wd Q-S
8 Class of work: XNEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑MOVE ❑ REMOVE (�
9 Describe work: te. Y1,0I 4 A" e-
10 Change of use from
Change of use to
11 Valuation of work: $';f -U PLAN CHECK FEE PERMIT FEE / y
J y'
SPECIAL CONDITIONS:
Type of Occupancy
Const. Group Division
444 Size of Bldg. No.of Max.
(Total)Sq. Ft. Stories Occ. Load
Fire Use Fire Sprinklers
APPLICATION ACCEPTED BY: PLANS CHECKED BY PP VIED FOR ISSUANCE BY Zone Zone Required ❑Yes ❑No
A No.of� OFFSTREET PARKING SPACES:
�/
welling Units Covered Uncovered
N 0 T I C E Special Approvals Required Received Not Required
ZONING,
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-
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
I 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 (D TTE) (Q�
91G<AU OF OW ER IF OWNER BUILDER DATE
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CAS►r
` /
SHELTON PRINTING CO.
I,/
,