HomeMy WebLinkAboutBLD28189 BLD2010-01150 Mobile Home - BLD Permit / Conditions - 5/24/1991 12/16/2010 12:48 FAX. 360 427 7798 MASON CO PERMIT CTR Z 002
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Shorelines: pltmbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:
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%oke Detector:
Remarks:
Setback: -
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Foundation
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Fireplace:
Wood Stove: -
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TYPE MOBIU HOI,E
Permit No. 28189 No. Floors Sq Ftg 924_ _
Owner K�, r F. Tel 0123 Date .�-24-91
Address .O. Box 157 Ke r Zip
Contractor e
Address p
Legal Description 7-22-1 lot 2 WZ
Direction toi projectto`�rom "�'
Raod to Horse Ranch on .r'1gfjt 10t ahead on left E 93
Razor Road
ing Mechanical Sewer Wood Stb-Ve
fireplace Deck 7a--rag e - sport
sement soft —tether
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MASON COUNTY PERMIT Na_23 �9 Z0161166
BUILDING PERMIT APPLICATION
426 W. Cedar • P.O. Box 186, Shelton, WA 98584 R'E=CN CN AN
Shelton (360) 427-9670 • Belfair (360) 275-4467 • Elma (360) 482-5269 EXPIIZED "��'''
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner-L=& EARL ANER62V TCTN& TM WARD Company Name
Mailing Address 309 IUM SIM Mailing Address
City I DI1N State IT Zip Code 840T City State Zip Code
Phone RA-829-4008 Other Ph. Phone Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail address FAIL `Q•MM E Mail Address
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System U11
Well Water System Name of Water System
PARCEL INFORMATION - 12 Digit Parcel No 1??Q775gn592 Fire District
Legal Description LOT 52-B OF RM PLAT NO. 2472
Site Address (Please include street name, street number and city)2001 E. RAC RW, BELFAIR, WA 98528
Directions to site
Will timber be cut and sold in parcel preparation? Yes o
Is property within 200' of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs ] 15%
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes
TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building REETTIM'TAT Describe WorkfEiAL It'=CN CN AN EXPIRED PERMIT
No. of Bedrooms 2 No. of Bathrooms 1 Square Footage- 1 st Floor 924 2nd Floor
3rd Floor Basement Deck Covered Deck Other Sq. ft.
Garage Attached Detached Carport — Attached Detached
MANUFACTURED HOME INFORMATION - Make REEMV Model Year1991
Length 70 Width 14 Serial No. 11816228 No. of Bedrooms 2 No. of Bathrooms 1
Type of Heat Purchase Price$ Replacement Unit? Yes/No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below. I declare that I am the owner,owners legal representative,or the contractor. I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained
permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF OX CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. j
X - LG I`1Cl 61 Date:
Own wners Re resentativ /Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee Planning Review Fee
Mechanical & Base fee Other
Wood/Gas/ Pellet Stove Fee State Fee
Violation Fee I Pre-Paid at Submittal
Valuation $ TOTAL FEES