HomeMy WebLinkAboutBLD2000-00727 mobile - BLD Permit / Conditions - 7/6/2000 p o ° -I O X
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final ti
date by date b date � ��f-2 - by , s
FRAMING Walls y FIRE DEPT.
I date by date by
PLUMBING date by OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
7f}�S 14
I
n_
PERMIT NO.: BLD
MASON COUNTY
BUILDING PERMIT APP (CATION
426 W.Cedar/P.O.Box 186,Shelton,W 98584
Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482 5269 Seattle 206 464-6968
APPLICANT INFORMAT.ON CONTRACTOR INFORMATION
Owner Contractor fame
Mailing Address rC'' Mailing Add � ss
City 1/ State' <,A Zip Code City State Zip Code
Phone( )-;f27Q6'1' Other Ph.( ) Ph.( Other Ph.0
Lien/Title Holder Contractor Reg. #
Address Expiration
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
System Name of Sewer System Well Water System Name of
Water System
PARCEL INFORMATION-12 digit Tax Parcel No. Fire District
Legal Description '
Site Address(Please include street name, street number and city - /h/S
Directions to site
/ /
Will timber be cut and sold in arcel preparation? (Yes/No) A, '}
Is your property within 200' of the following: Body of Water(Name) Saltwater
Lake River/Creek Pond Wetland Seasonal Ru off Stream Slopes or
Bluffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑
TYPE OF JOB New Add Alt Repair Other USE, of Building
Describe Work
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st :]oor 2nd Floor
3rd Floor Loft Basement Deck Otheri sq. ft.
Garage Attached Detached Carport Attach d Detached
MOBILE HOME INFORMATION-Make ' del Model Year
Length Width Serial No. 7 No. of Bedrooms No. of Bathrooms `
Type of Heat -'!e " Purchase Price $ l p Replacement Unit ?(Yes/No)
Installer Name Certificatio No.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WI HIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYSIAT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the Above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-1 certify that I am exempt from the requirements of the CONTRACTO ,'S AFFIDAVIT-1 certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in thd State of Washington and that I am aware of the ordinance
requirements for which this permit is issued and that all work will be done in requirements re ulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
approval. first obtaining approval.
•:
X Date X Date
FOR OFFICIAL USE BEYOND I HIS POINT
Accepted b !✓ �' Date Submittal Amouni Due Receipt No.
IJFARTIYIENTAI» RUIEW ROv DEN!>wU WWI CO.
E
. _ __
Building Department /
Occ Group Type Constr.
Planning Department
Environmental Health Department
Public Works Department
I
Fire Marshal
Valuation $
_. ...... . ......... ..._._.. . ......... ................... _.._..... .......:.. ..... . ......._ ......... ..... ... . _..
.. .. ... ...
Building Permit Fee Site Inspection
Plan Review Fee UFC Plan Revi w Fee
Plumbing & Base Fee Public Works eview Fee
Mechanical & Base Fee Other
Wood/Gas/Pellet Stove Fee Other
Violation Fee Pre-Paid at Sul mittal ( )
TOTAL FEES
...........................
MA ON COUNTY PROJECT SITE INFORMATION
CaseNo.
Name ta, * t & ,`' fC� PARCEL NUMBER s lG ' Date
SHOW THE FOLLOWING ON SITE PLAN Show Direct on by indicationg N, S, E, W in relation to the
site plan
Lot Dimensions Fences
Existing Structures Driveways
Structure Setbacks Shorelines (V
Water Lines Topography
Well Location (including adjacent) Drainage Plan
Names of Streets Easements
Names of Fronting Streets Septic System
DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or ithin 100 feet of adjacent property line.
adjacent property line4 I //V E-adjacent property line
1 I
I
I I
I I
\'
I I
I I E-adjacent property line
dacent
SAMPLE SITE PLAN
adjar�nt property lined r E-adjacent property line
t7 30 Rv —
CREEK I Ho L, I .la f16.61U
I � I
PrioPosat) smpt:
I I
VACAwJT I T crnRAc.6
I 3o j
I(� P0.oPnsCD
\ \ NfsR iCLLL AL So
I %.
I
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adjacent property lined , Ate. \I E-ad'aaent properiy line
TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, Cuts and fills. If possible include height and the
degree of slopes. See sample topography profile.)
SAMPLE OPOGRAPHY PROFILE
dtstar.cm to
ruttl,�Y�
dcsta"C.G to
510P'Z fie¢
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fo R
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Signature Dat
MOBILE HOME
kAL ESTATE EXCISE TAX AFFIDAVIT
Submit to County Treasurer of the county Chapter 82.45 RCW This form is your receipt when stamped
in which property is located. Chapter 458-61 WAC by cashier.
FOR USE WHEN TRANSFERRING TITLE TO MOBILE HOME ONLY
PLEASE TYPE OR PRINT
INCOMPLETE AFFIDAVITS WILL NOT BE ACCEPTED
Name A Name
� x Hx
ww �
Hz
3 Street W O Street
wO 3
C4 City State Zip Code W City State Zip Code
Name Name
w w �
O � w
o
z zx 3
O o
w
Street J Street
U W
0 0 C7
a � City State Zip Code W City State Zip Code
PERSONAL PROPERTY REAL PROP RTY
PARCEL or ACCOUNT NO. PARCEL or CCOUNT NO.
MAKE YEAR MODEL S12E SERIAL NO.or I.D. REVENUE TAX
CODE NO.
I
Date of Sale
AFFIDAVIT
Taxable Sale Price.........................................$ I Certify Under Penalty Of Perjury Under The Laws Of The State Of
Excise Tax: State........................................$ Washington That The Foregoing Is True And Correct.
Local.......................................$ Signature o
Delinquent Interest: State.............................$ Grantor/A agrent
Local............................$ Name(pri )
Delinquent Penalty: State.............................$ Date and P ace of Signing:
Total Tax,Interest&Penalty Due..................$
If exemption claimed,WAC number&title: Signature o
WAC No.(Sec/Sub) Grantee/Agent
WAC Title Name(print)
A MINIMUM OF$2.00 IS DUE AS A PROCESSING FEE AND TAX. Date&Pla a of Signing:
g
TREASURER'S CERTIFICATE
I hereby certify that property taxes due
County on the mobile home described hereon have been paid to and If,in sellin (or otherwise transferring own rship of)a mobile home
including the year which poss sses a tax lien the seller does not inform the buyer(new
owner)of such a lien,the seller is guilty of deliberate deception as it
applies r Theft as defined in Title 9 and 9A RCW(RCW
Date County Treasurer or Deputy 9.45 '1�'56.010(4d),and RCW 9A.56.020).
TREASURER'SL ESTATE o
EX ISE TAX
PAI
1
JUN 2 2000
D01t NE RAY,
1-klloq Oho" 1vounq
REV 84 0003(6-05-98)(PD 1-04-99)
TAXPAYER
STATE OF WASHINGTO
DEPARTMENT OF LIC NSING
,
iMpOR cEA KEEP
F V
@Xs youS veSIGV FHIGLEI
V
to pire thicie sseOTTO ESSIFC
s on
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rasp under " he da sh registratio
ponsible f,EG-E p„ Yon` at then,
the expiration Bang prior to
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CUSTOMER'S 6604 � ,