HomeMy WebLinkAboutBLD1545 Final ReRoof - BLD Permit / Conditions - 2/18/1975 LL J
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BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584
DATE_-.-2—i/=7�
/�-OC"r
PERMIT N0. __ _ a
Applicant to complete numbered spaces only. u
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JOB ADDRESS
LEGAL L �
DE (�3EE ATTACHED SHEET)
1 SC R.
OWNER MAI�L�D�'� 21P���-P� PHONE
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2 `.
CONTRACTOR MAIL ADDRESS PHONE LICENSE NO.
3
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ARCHITECT OR DESIGNER 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: $ / QO C c
PLAN CHECK FEE �0 y� 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
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY. Zone Zone Required ❑Yes []No
"', No. of OFFSTREET PARKING SPACES:
v Dwelling Units Covered Uncovered
N 0 T I C E IF Special Approvals Required Received Not Required
ZONING.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEALTH DEPT.
HEATING, VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION FIRE DEPT.
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC- OTHER ISDOClfy)
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 Or CONTRACTOR OR AUTHORIZED AGENT (DATE)
SI GNAT RE OF OWNER IF OWNER BUILDER DATE)
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION c►c. j M.O. CASH
SHELTON PRINTING CO. •� -