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Home My WebLink AboutBLD25523 & PERMIT W/NO NUMBER DATED 3/19/90 FOR REMOVAL OF 5 BEDROOM HOUSE - BLD Application - 4/23/1990 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED 2610 n PERMITNO. OWNER rNAME MAILADDRESS CITY&STATE ZIP PHONE / DIRECTIONS 74 - - / TO JOB SITE E 7 7 o Sh r uJv v k PARCEL LEGAL _ NUMBER �d'LvL 3(J i� C�( J DESCR. T., 7 CONTRACTOR SAME MAIL ADDRESS ICQITY&STAIt: LICENSE NO. ZP PHONE USE OF BUILDING CLASS OF , NEW WORK ✓ a�� ADDITION ALTERATION REPAIR MOVE REMOVE DESCRIBE WORK �. '67 h c- '�. :q70 4OL BEDROOMS_ DECKS CARPORT NOTICE BATHROOMS TOTAL SQ.FT. GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT TOTAL SQ.FT. FIREPLACE DETACHED COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PERMANENT ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. SHORELINE _. SEASONAL OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIF* THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF , REGIST TION LAW RCW 18.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND 1 AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUI MENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN IN CO FORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING 01 ING APPROVAL FROM THE BUILDIN F.PARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. X O NER �i- ATE X BY DATE FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED YES No YES NO BUILDING VALUATION HEALTH PUBLIC WORKS vC/ FEE PLANNING FIRE BUILDING PERMIT D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE APPLICATIO STATESURCHARGE HECKBY APP VED F 7ISSUANCE PERMIT VALIDATION BY ��' / � CASH CK MO TOTAL t7� BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 Q Q 427-9670 DATE ISSUE I PERMIT NO.' OWNER NAME '-' w Se Il el-s MAILADDRESS CITY BSTATE ZIP PHONE DIRECTIONS TO JOB SITE PARCEL LEGAL NUMBER ' DESCR. NAME MAIL ADDRESS U CONTRACTOR `CITY&STATE LICENASENO. ZIP PHONE USE OF BUILDING CLASS OF NEW WORK ✓ ADDITION ALTERATION REPAIR MOVE REMOVE Y DESCRIBE WORK BEDROOMS_ DECKS CARPORT NOTICE BATHROOMS TOTALSQ.FT. GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT TOTALSQ.FT. FIREPLACE COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PERMANENT SHORELINE SEASONAL OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRATION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. X OWNE ✓� DAT X BY DATE F R OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED YES NO YES No BUILDING VALUATION HEALTH PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT D.O.T. BUILDING �� PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE STATESURCHARGE APPLICATION ACCEPTED BY �PILANS CHECK BY rBY' ROV D OR ISSUANCE PERMIT VALIDATION ' — 11� � CASH CK MO TOTAL PLOT PLAN ADDRESS Z'' PERMIT N0. LEGAL DESCRIPTION ° LOT BLK ADDITION -------------- Y SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq.Ft. k Sf pd I, INSTRUCTIONS TO APPLICANT THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA- TION AND SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR- TION THEREOF. INDICATE NORTH IN CIRCLE V .1fAL[a�Q�f d \ - 77 \ 0 \ \ r� I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without first obtaining approval. -'-El OF OWNER(S) OF SITE \ sT UCTUR ( ) (PRIN T) TORE OF OWNER(!) OR AUTHO I D R P ESENTATIVE D0NOTWRjrE8ELZV1TH1SL1NE APPROVED DISTRICT AS NOTED DATE S. Gordon Craig the �. mason county assessor Dear We have recently received a copy of tax certificate for mobile home movement on your mobile home. In order that we may accurately value you mobile home, please complete the questions below and return this form to our office by It is imperative that this information be provided to prevent a possible double assessment. MOBILE HOME DATA LENGH 70 WIDTH / MODEL MAKE MODEL YEAR 6— MOBILE HOME LOCATION INFORMATION SERIAL #>,;-,�,,-� �2 2 a A. My privately owned land. YES NO '-�- B. If rented or leased land who from? NAME ADDRESS.0 , CITY & STATE /9 C. Real Property Parcel / (tax statement #) 61 D. Mailing name and address for owner of mobile home NAME ADDRESS 7,2 CITY & STATE E. Location address of mobile home CITY F. Date mobile home was placed on present site C. Purchase Price a �DATE: SIGNATURE TYPE OR PRINT NAME TELEPHONE NUMBER Courthouse Shelton, Washington 98584 Phone 4?7-9670