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Home My WebLink AboutBLD92-0068 Mobile Home - BLD Permit / Conditions - 5/11/1992 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES 426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584 ^� 427-9670 DATE ISSUED PERMIT NOw6 ld qO2 Q OWNER AME _ MAILADDRESS CITY&STATE ZIP PHONE L, L �f0 '7 s'2 Z DIRECTIONS TO JOB SITE �►/� [, 4- ..wry 6 364leLQ / ' FF T - taLL 15 '-e- S, PARCEL LEGAL tom_ 423 NUMBER 19364 51 no9ol IDESCR,. fj `7 -Lt. I CONTRACTOR NAME MAILADDRESS CITY BSTATE ZIP E LIDEMN0. USE OF BUILDING WORK r CLASS OF NEW ADDITION [ALTERATION REPAIR FMOVE REMOVE DESCRIBE WORK mE-c' SS U L L I \1 G �p M'Efy l S-L 07 1 C_ — C L (- c C in 0 )Lk Idyin 9- AREA: NUMBER F: PLEASE INDICATE: NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR RESIDENCE UbLSgFt STORIES _ SHORELINE❑ CONDITIONING. BASEMENT SgFt BEDROOMS Z PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT DECKS SqFt BATHROOMS SEASONAL RES.❑ COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED. CARPORT SgFt FIREPLACE IS CARPORT/GARAGE GARAGE SgFt ATTACHED O DETACHED a OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT 1 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. N CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING APPROVAL FROM THE BUILDI G DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. X OW R ATE �c/ X BY DATE FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION YES NO YES NO HEALTH MT' PUBLIC WORKS zoo FEE PLANNING FIRE MARSHAL BUILDING PERMIT D.O.T. BUILDING PLAN CHECK NA SPECIAL CONDITIONS BUILDING GROUP E-INSPECTION SHORELINE # WOODSTOVE tn-iE�Mbm:a Lzgg�tug PLUMBING m MECHANICAL e{ CC r k STATE BUILDING FEE APPLICATION ACC PTED BY PLANS CHECK BY JAPP=ERCE PERMIT VALIDATION BYCASH CK MO TOTAL /� MAILADDRESS CITY&STATE ZIP PHONE • L t . DIRECTIONS • TO JOB SITE PARCEL YAM ■��%i��IIL�Tii�ii�r��,1■ the mason county assessor Darryl Cleveland Dear We have received a copy of the tax certificate for movement of your mobile home . In order that we may accurately value your mobile home , please complete the questions below and return this form to our office by This information is imperative to prevent a possible double assessment on your mobile home . MOBILE HOME DATA LENGTH WIDTH o2 (// / MODEL MAKE 42 / GCJfS% MODE YEAR MOBILE HOME LOCATION INFORMATION SERIAL 4 GU 140 A. My privately owned land yes no OR B. If rented or leased land who from? NAME ADDRESS CITY rB STATE C . Real Property Parcel # ia3o 6 51 O"-I d/ ( from tax statement of new location) D. Mailing name and address for owner of mobile home NAME FL 1' �l y. — ��'t�N C-s I" ADDRESS LIE // WO CITY & STATE �'�'I _ G[��✓ r. 'II E . Location address of mobile home City !E F . Date mobile home was placed on present site G. Purchase Price DATE d SIGNATURE TYPE OR PRINT NAME OeLD-E N t1, f L EA j TELEPHONE NUMBERL,�06 ) -17 z f ON --Ok 2 Z C40 .4Z ac OD Z ...� ( ) O c (> 7- Z mr C 'S st or aw 'IV A 4P 10 op �m OD C) f. CA x Z qw lip 1p 2.4 is wr CONCRETE MECHANICAL MOBILE HOME Footings-Setback date Ribbons date by Gas Piping date " by Foundation Waits date by Set Up date by INSULATION date by BG/SLAB Insulation Floors Final date by date by date by FRAMING Waits FIRE DEPT. date by date by date by PLUMBING Attic OTHER Groundwork date by date by WALLBOARD NAILING D.W.V. date by date by FINAL INSPECTION Water Line date by date by date by a= r �. . ; _ OQ r- p D ♦/) x 0 V/ - ODp 0 CL v 7 Y D CA 10 Q 1 -� Q 1 I I I I i I I I I I I 00 vo o I xn I Eo0 0 ON c �Z Co D 0, 00 (D I ..OD Q cn I I I I I I _r I, i _ _ CONCRETE MECHANICAL MOBILE HOME Footings-Setback date by Ribbons date by Gas Piping cat Foundation Walls date by Set UP clate by INSULATION date q2 by BG/SLAB Insulation Floors Final date by date by date by FRAMING Walls FIRE DEPT. date by date by ' date by PLUMBING Attic OTHER Groundwork date by dace by WALLBOARD NAILING D.W.V. date by date by FINAL INSPECTION Water Line date by date by date by the mason county assessor Darryl Cleveland Dear We have received a copy of' the tax certificate for movement of your mobile home . In order that we may accurately value your mobile home , please complete the questions below and return this form to our office by E. This information is imperative to prevent a possible double assessment on your mobile home . MOBILE HOME DATA LENGTH WIDTH /> J +�� - MODEL MAKE t�D �Kle,17 �<fS% MODELGfJ�;i-�'/�/Ae YEAR MOBILE HOME LOCATION INFORMATION SERIAL # ZV A. My privately owned land yeses_ no OR B. If rented or leased land who from? NAME ADDRESS CITY & STATE C . Real Property Parcel : 1,;?305 51 0(1-'Cl01 ( from tax statement of new location) D. Mailing name and address for owner of mobile home NAME --13 E--LD,-,V �. CR F)NeC-J ��. t` L K� ADDRESS // /YO . /YG/So W CITY & STATE E . Location address of mobile home-:�,e,-, City F . Date mobile home was placed on present site — U� G. Purchase Price — ti DATE d y SIGNATURE TYPE OR PRINT NAME \Bel T i TELEPHONE NUMBER( I.