HomeMy WebLinkAboutBLD5415 Dormer - BLD Permit / Conditions - 6/17/1977 ' Leitch, M. R. #5415
6-17-77
5th and Seattle St. , Union
Blk 51 Lots 37-40 Union
Dormer
$1,000.00
45 '-:z 3 -77 019
BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED /� 7 177
PERMIT NO.
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
. R. LEIT'GH ra EFOX i A/•'o xe,
DIRECTIONS
TO JOB SITE S'?".h a,. SE'ATT L E .57"3. WmfoAl
LEGAL (❑ SEE ATTACHED SHEET)
DESCR. BLOC iK S � L OT.s 3 7- 40 PC47 4 N--oa/
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR F
USE OF
BUILDING
Class of work: J1 NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
N -r-4 Roo
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
OOOi 0
SPECIAL CONDITIONS:
API"ICATION ACCEPTED BY1 PLANS CHECK BY APPR V D FOR I ANCE Type of Occupancy Division
B Const. Group
GA-
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I Certify that I am a currently registered Contractor in RESIDENCE
the State of Washington and I am aware Of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
HEALTH DEPT.
Firm PUBLIC WORKS
By
ROAD DEPT.
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be in conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
,,,� IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPE
Owner
/. .� 4 4`'/7'C/� Date. —1 WORK IIS COMMENCE pDED OR NED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
PL N CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH