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Home My WebLink AboutBLD75-1889 - BLD Permit / Conditions - 5/23/1975 Jeffries, Howard R. #1889 5-23-75 W2, WZ. W2, SW4, N. of R/W, 8-20-4 (Dayton) Mobile Home r BUILDING PERMIT APR (CATION MASON COUNTY DEPARTMENT of GENERAL SIERVICES 426 W.CEDAR/P.O. BOX 186 SHELTON,WA HINGTON 98584 427-9670 DATE ISSUED PERMIT NO. NAME C;MAIL ADDRESS CI Y&STATE Z P PHONE OWNER DIRECTIONS - //� / TO JOB SITE G>� T �� f'OyL��v� GI L fivt y`2 n ,6-/-3(- PARCEL LEGAL] + / - ��—'_1v NUMBER - DESCR � CONTRACTOR NAME MAILADDRESS CITY&STATE ZIP PFI00 LICENSE NO. USE OF BUILDING CLASS OF NEW ADDITION ALTERATION PIA IR MOVE REMOVE ✓WORK DESCRIBE 1 WORK _ l0( G� dJ I L� �1- moo. J �C/�L `� rrrfta AREA: NUMBER OF: PLEASE INDICA E: OTICE S PARATE PERIVITS ARE RE IRED FOR PLUMBING, HEATING, VENTILATING OR AIR RESIDENCE SgFt STORIES SHORELINE❑ C DITIONING. BASEMENT SgFt BEDROOMS PRimA\3Y RES.O THIS RMIT BECOMES NULL ND VOID IF WORK OR COSTRUCTION AUTHORIZED IS NOT COMM�CED Wi IN 180 ' YS, OR IF CONSTRUCT( N OR WORK IS SUSPENDED OR DECKS SgFt BATHROOMS SEASONA RES.❑ ABANDONED FO PERIOD F 180 DAYS AT ANY TIME A TER WORK IS COMMENCED. CARPORT SgFt FIREPLACE_ CARPOR NDACHED AGE GARAGE SgFt A�7ACHED ❑ 4 OWNERS AFFIDAVIT ONTRACTO.,S A FIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIR ENTS 0 THE CONTRA TORS I ERTIFY THAT IAA A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF REGISTRATION LAW RCW 18: 7, AND AM AWARE OF T MASON OUNTY ORDIN CE W HINGTON A 1 M AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND AT ALL WORK DONE WIL BE WORK FOR WH H THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN IN CONFORMANCE THEREWITH. O CHANGES SHALL E MADE WITHOUT FI T CONFORMANCE E EWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING APPROVAL FROM THE BU ING DEPARTMENT. APPROVAL FROM HE BUILDING DEPARTMENT. WNER D�CTE X BY DATE FO OFF1 E USE N LY DEPARTMENT APPROVED DEPAR ENT APPROVED BUILDING VALUATION YES NO YES NO HEALTH PUBLIC ORKS FEE PLANNING FIRE MARSHAL BUILDING PERMIT D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE APP06ATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATI N BY CASH CK MO TOTAL BUILDING PERMIT APPLICATION MASON COU TY P. O. Box 400 Shelton, Wash gton 98584 f 0 DATE 'a m D PERMIT NO. p Applicant to complete numbered spaces only. N JOB ADDRESS HIE 1, 1 LEGAL G` I / SEE TT� ED OWNER MAIL ADDRESS ' ZIIP PHONE (.� ` 2 CON TR AC/T�O/R)� MAIL ADDRESS A DDDRESS PH j I.�l. � I P l C � ONE LICENSE NO. 3 � 'f� r ARCHITECT OR DESIGNER MAIL ADDRESS PONE LICENSE NO. 4 Ivy ENGINEER MAIL ADDRESS PONE LICENSE NO. li^ 5 V,' LENDER MAIL ADDRESS BRANCH 6 USE OF BUILDING 7 8 Class of work: ,❑( NEW ❑ADDITION ❑ALTERATION ❑ REPAIR ❑MOVE ❑ REMOVE 9 Describe work: C D I I 10 'Change of use from Change of use to 11 Valuation of work: $ �. PLAN CHECK F EE 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. AP ROVED FOR ISSUANCE BY: Zone Zone Required ❑Yes ❑No No.of OFFSTREET PARKING SPACES: �sJ welling Units Covered Uncovered N 0 T I C E IV .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 (Specify) TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. 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. SIGNATUR CONT CT A OR AUTHORIZED AGENT (DATE) /7 SI NATURE OF OWNE F O ILDER DATE) P AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK. M.O. CASH SHELTON PRINTING CO. BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERALSERVICES 426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. NAME MAILADDRESS C &STATE ZIP PHONE OWNER e DIRECTIONS TO JOB SITE LEGALPARCEL sU�w DESCR. / , // J `j NUMBER CONTRACTOR NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO. USE OF BUILDING CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE WORK ✓ DESCRIBE WORK 0201A3tL AREA: NUMBER OF: PLEASE INDICATE: NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR RESIDENCE SgFt STORIES SHORELINE❑ CONDITIONING. BASEMENT SgFt BEDROOMS PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT DECKS S Ft BATHROOMS SEASONAL RES.❑ COMMENCED WI HIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR g ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. CARPORT SgFt FIREPLACE IS CARPORT/GARAGE GARAGE SgFt ATTACHED O DETACHED❑ OWNERSAFFIDAVIT 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 I HEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM' HE BUILDING DEPARTMENT. / ` Z X OWNER DATE / 2- r X BY DATE FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATI N YES NO YES NO HEALTH PUBLIC WORKS FEE PLANNING FIRE MARSHAL BUILDING PERMIT D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE A P TION ACCEPTED BY PLANS CHECK BY FBY ED FOR ISSUANCE PERMIT VALIDATION TOTAL CASH CK MO 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 S WIDTH ft� � MODEL MAKE Tle- MODEL YEAR MOBILE HOME LOCATION INFORMATION SERIAL # A . My privately owned land yes no OR B . If rented or leased land who from? NAME ADDRESS CITY & STATE C . Real Property Parcel # g,.Q oo-% 3o &000Q ( from tax statement of new location ) D . Mailing name and address for owner of mobile home NAME l ; ,4 A 0 0 R E S S WOR1�'Z- � A2j7 Oyl- A I T Y & STATE (4j,�_ E . Location address of mobile home ,_._ City f?- F . Date mobile home was` placed on present site C� G . Purchase Price ✓ b 0 DATE___ tZ SIGNATURE TYPE OR PRINT NAME II�� TELEPHONE NUMBER 2'6 4 Al i Ni