HomeMy WebLinkAboutMIS92-0016 MOBILE HOME STORAGE - MIS Application - 5/12/1992 BUILDING PERMIT APPILICATIOW IS9 2- 001 CIS
r y? b T` Mf MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
DIRECTIONS LAry 4,j
TO JOB SITE p,- j}IRpv.2i-j).x Tc rQ � tretG ALA— rvtl_. S _j
PARCEL LEGAL
NUMBER Dip �p�s$'j DESCR.
NAME MAILADDRESS CITY&STATE ZIP PHONE .'L0 LICENSE NO.
CONTRACTOR Gh#fCkie_s No/n< L v ."�a a - 44 hct7c.!1
USE OF
BUILDINGtS1
CLASS OF NEW X ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
AREA:4r
REA4r IX S d Si; NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMNTS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE 13 SgFt STORIES SHORELINE CONDITIONING.
BASEMENT NA' SgFt BEDROOMS PRIMARY RES..A THIS PERMIT BEC MES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS S Ft BATHROOMS a SEASONAL RES.❑ COMMENCED WI HIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
g ABANDONED FOF A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
CARPORT_/�'/A SgFt FIREPLACE ?-Z IS CARPORT/GARAGE
GARAGE Al-A SgFt ATTACHED O DETACHED O
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.
C/lARL �aa Y-;— ce.Jr.'L
XOWNER DATE XBY DATE 73 ' 9
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT ED BUILDING VALUATION
YES NO YES.
NO
HEALTH PUBLIC WORKS RFE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
+ WOODSTOVE
(� I 3 t I f PLUMBING
C r c
r MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY PLANS CHECK BY APPR VED FORJSSUANCE PERMIT VALIDATION
TOTAL
B CASH CK MO
BUILDING PERMIT PLOT PLAN
MASON COUN
DEPARTMENT of GENERA SERVICES
P.O. Box 186 SHELTON, WAS NGTON 98584
427-9670
DATE ISSUED
PERMIT NO.
NAM ALA R & ATE ZIP PHONE
OWNER 8 s6''e.�- ��rz o 11ax lr-?-7 e-v
DIRECTIONS
To J08 SITE txt csT p,v r%1 �'.- a,a. j o�` /1a
......... z
PARCEL LEGAL
NUMBER �I�oQso DooS? 1 0E5CR w
Indicate below. 0 Property lines and dimensions.
* Easements and roads
O Septic, drainfield anc=reserve area, or se r.
0 Septic tank and drainfield setback distanc im from foundations
G Location of proposed construction on pro erty.
0 0 Building & septic system setback distance from all property lines 8 easems ,�c y
Indicate North A AAEstiand waterline
In Circle O Saltwater, lakes, rivers, streams, wetlands, rain
age.
O Attach copy of septic system as built" or ptic permit approval.
O Indicate topography profile of property an structure on reverse side.
� I V
r
Q j- --j- -
--
� s
C
0
VW*C*Mty that the 01`00030d Construction woo wntorm to the dimenSWns end uses Shown
aoOve at, thii n0 Ch3nQe3 wdl be mace without fast 0014�nlrs(;
SIGNATURE OF NERS)OR AUTHORIZED REPRESENTATIVE
00 NOT WRITE BELOW THIS LI E
�- the
mason county
assessor
Darryl Cleveland
Dear
We have received a copy of' the tax certi fii ate for movement of your
mobile home . In order that we may accuii ately value your mobile
home . please complete the questions belo ' 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 WIDTHb` �
MODEL
MAKE n. MODEL � YEAR
MOBILE HOME LOCATION INFORMATION SERIAL # 'Y ,
A. My privately owned land yes - no
OR
B . If rented or leased land who from? NAME
ADDRESS •r 1 %�',��o`� e.�'t"' CITY 8 STATE
C . Real Property Parcel # �266 Co 3 ( from tax
statement of new location )
D . Mailing name and address for owner of mobile home
NAME
ADDRESS J0 91x CITY $ STATE /4- eL)
E . Location address of mobile home% SS3 ,�rviad U'LL'���CityS`irZ%c'.�
F . Date mobile home was placed on presen site
G. Purchase Price
DATE /S yr` SIGNATURE A u- �
TYPE OR PRINT NAME
TELEPHONE NUMBERII