HomeMy WebLinkAboutMobile Home #308 - BLD Application - 9/29/1989 BUILDING PERMIT APPLICATION
1 MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
VVVV 427-9670 DATE ISSUED
PERMIT NO.
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER E �C ' Z6-�/
DIRECTIONS
TO JOB SITE � `� �oQ e OnPARCEL LEGAL
NUMBER 2G:�� 133�4� D SCR. bs/ G y SW
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR E
ve
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
E �s
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS�_ TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. 5'00 FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
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 AP OVAL FROM THE LDING DEPARTMENT. 9 APPROVAL FROM THE BUILDING DEPARTMENT.
Z9
bla
X OW �- TE4 Z r � X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING 141c, PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVE FOR ISSUA CE PERMIT VALIDATION
Y l0��
TOTAL
CASH CK MO
I
S. Gordon Craig
the
mason county
assessor
Dear
We have recently received a copy of tax certificate for mobile home
movement on your mobile home.
In order that we may accurately value you mobile home , please complete
the questions below and return this form to our office by
It is imperative that this information be provided to prevent a
possible double assessment . `
MOBILE HOME DATA LENCH WIDTHMAKE /
MODEL f
L /rrYl c- MODEL YEAR / Z
MOBILE HOME LOCATION INFORMATION SERIAL # Vj/V 5 �7
A. My privately owned land. YES NO
B. If rented or leased land who from? NAME
ADDRESS CITY & STATE
C. Real Property Parcel # (tax statement #) Z�200 / �� `'. 0
D. Mailing name and address for owner of mobile home
NAME �L ��
ADDRESS 420/ eyo fS�/ �"O� CITY & STATE- {�, ,/W� /�a 01�r�
E. Location address of mobile home_�,6# fg �b0 CfTY
F. Date mobile home was placed on present site
C. Purchase Price ��
DATE: �' � ! SICNATURE P,4
TYPE OR PRINT NAME PL- �cj- F��npC/�C
TELEPHONE NUMBER
Courthouse Shelton,Washington 98584 Phone 427-9670
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