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Home My WebLink AboutBLD13839 Deck ,BLD12133 Mobile Home - BLD Application 4-'- �8UILDING -PERMITAPPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 426-5593 �✓!_�� DATE ISSUED PERMIT NO. OWNER NAME MAIL ADDRESS CITY 6 STATE ZIP PHONE If DIRECTIONS / TO JOB SITE n,cfla a Lzk4E_ LEGAL (0 SEE ATTACHED EET) DESCR. 3 CONTRACTOR NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. PHONE USE OF BUILDING Class of work: ❑ NEW IRADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: 1rX L10 r Valuation of work: $ O PLAN CHECK FEE PER SS(Q��FEE3C JV SPECIAL CONDITIONS: a BEDROOMS IDECKS CARPORT ❑ NOTICE BATHROOMS TOTAL SO. FT. GARAGE ❑ ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES_ BASEMENT ❑ OR AIR CONDITIONING. TOTAL SO. FT. FIREPLACE ❑ DETACHED ❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR- CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER I certify that I am a currently registered contractor in WORK IS COMMENCED. the State of Washington and I the aware of the FOR OFFICE USE ONLY ordinance requirements regulating the work for which the permit is issued and all work done will be in //�1 conformance therewith. PERMANENT ❑ SHORELINES of SEASONAL ❑ FLOODPLAIN ❑ Firm. E.D. NO. S.E.P.A. ❑ By Special Approvals IN OUT YES APPROVED NO Lic. No. Date ZONING PLANNING DEPT. OWNERS AFFIDAVIT HEALTH DEPT. PUBLIC WORKS I certify that I am exempt from the requirements of the FIRE MARSHAL contract or registration law RCW 18.27, and am aware BUILDING DEPT. / g of the Mason County ordinance requirements for which this permit is issued and that all work done will ROAD ACCESS be in conformance therewith. MOTOR VEHICLE PERMIT ownerxgx� Date. A LIGATION AC E TED•BY PLANS CHECK BY APPROVED FOR ISSUANCE �` Y -•3 P CHECK VALIDATION CK. M.O. CASH RMIT VALIDATION CK. M.O. CASH MASON COUNTY P.O. Box 186 Shehon, Washington 98584 42&5593 DATE ISSUED 30l Emerald fake I�r. �UPSr PERhHTNO.OWW, A NAME MAIL ADDRESS CITY&STATE ZIP PHONE 74) ... t 9g la 1 DIRECTIONS TO JOB SITE LEGAL (O SEE ATTACHED S�IEE1) DESCR. NAME MAIL ADDRESS CITY s STATE LICENSE NO. PHONE CONTRACTOR USE OF BUILDING Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: lox 9 Valuation of work: S /s 1 ..9 vOj/- PLAN CHECK FEE PER FEE Sp S SPECIAL CONDITIONS: BEDROOMS CL DECKS v CARPORT ❑ NOTICE BATHROOMS_ TOTAL SO. FT. GARAGE ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING,i HEATING, VENTILATING NO. OF STORIES_ BASEMENT ❑ ATTACHED O OR AIR CONDITIONING. TOTAL SO. FT. FIREPLACE El DETACHED ❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED CONTRACTOR AFFIDAVIT IS NOT COMMENCED WITHIN 12D DAYS, OR IF CO�STRUCTION'OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120(DAYS AT ANY TIME AFTER t certify that I am a currently registered contractor In WORK IS COMMENCED. the State of Washington and I the aware of the FOR OFFICE USE ONLY ordinance requirements regulating the work for which the permit is Issued and all work done will be in conformance therewith. PERMANENT SHORELINES ❑ SEASONAL❑ FLOODPLAIN ❑ Firm E.D. NO. S.E.P.A. ❑ By Special Approvals IN OUT YES APPROVED NO Lic. No. Date ZONING PLANNING DEPT. OWNERS AFFIDAVIT HEALTH DEPT. PUBLIC WORKS I certify that I am exempt from the requirements of the FIRE MARSHAL contract or registration law RCW 18.27, and am aware BUILDING DEPT. of the Mason County ordinance requirements for which this permit is Issued and that all work done will ROAD ACCESS ,ben in-conformance therewith. MOTOR VEHICLE PERMIT v�/ q;� µ ICATION A EPTE BY PLANS CHECK BY ROVED FOR ISSUANCE Ow /�.Aa� �V- Date.— _ / J I kf.LLLc/tC.[J P CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION K. M.O. CASH LOIS COTT ASSESSOR 0 THE MASON COUNTY AS S ES S 0 R DARRYLCLEVELAND CHIEF DEPUTY PLEASE SUPPLY THE FOLLOWING INFORMATION �,,''// REGARDING YOUR YOUR MOBILE HOME Owners Name:A' q` ,, W- wr�7`/CfJarlei F• jVl*, T e I e # 3-�-2• Mailing Address 3,2 /G� J C Previous Owners Name & Address I Description of Mobile Home: ( Information is on your registration certificate) Make 1,�1e, .� Size 3 C ya Y Serial Year Purchased IL Price (Less furniture d sales tax) $ ��• G, G If In Mobile Hcma Park: Naive of Park: Space # If N')T in Mlobile Hone Park: / Do you own the lard on which the home is placed? YES y NO ® Real Property description r meepl1 i✓ 2, Owner of Land If you are NOT -the Owner: Brief direction to location: Date Mobile Home Entered Mason County: Date you anticipate moving Mobile Home to another location: If moved from a Mobile Home Park give: Name of Park:. Space # I Your home will be placed on the rolls of Mason County. We would apprec ate a prompt reply. Please feel free to contact this office if you have any 4uestions at all . ' i i Very truly yours, �17� Helen Glaser Personal Property Department X Owners'S gnature Date 0 i r I J /k PLOT PLAN r DORESS G rYl(r a /a Z;i E PERMIT NO. 4 a i e 0 -GAL SCRIPTION LOT t;2- (O D f t/ 13 BILK ADDITION TE AREA Sp. Ft. AREA OF SITE OCCUPIED BY BUILDINGS_Sq.Ft. 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 BUILOING,SITE,ANDSETBACK DIMEN- SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA- TION ARID 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. O %O X 5' INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' 5' OA-1=.20_ t1a O ka � o I I/We artify that the proposed construction will conform to the dimensions and uses shown above and that no change will be made without first obtaining approval. AMEISI O. OWHERISI OF SITE S STRUCTURE(S) IPRINTI dIGNATURE OF OWNERISI OR AUTHORIZED REPI ESENTATIVE DO NOT WRITE BELOW THIS LIN£ APPROVED iSTRICT AS NOTED DATE .HE LT.. -Rw T�No