HomeMy WebLinkAboutMobile Home #410 - BLD Application - 2/5/1992 BUILDING PERMIT APPLICATION
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 TO JOB SITE ED
To
,j
PARCEL LEGAL
NUMBER DESCR. 1_j q
NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR l 'USE OF
BUILDING F `
CLASS OF NEW [ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
y
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES_� SHORELINE U CONDITIONING.
BASEMENT /rl -SgFt BEDROOMS Z PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS l COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
�SgFt BATHROOMS �_ SEASONAL RES.U ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT /r}-SgFt FIREPLACES IS CARPORT/GARAGE
GARAGE NA--SgFt ATTACHEDUDETACHEDA
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 T�ING DEPARTMENT. _ APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER DATE S / 2 X BY _ DATE
FOR OFFICE USE ONLY
DEPARTMENT YES NO
NO DEPARTMENT YES NoBUILDING VALUATION
5 76 -
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT 3 U 5�
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP } r PRE-INSPECTION
SHORELINE
r r n WOODSTOVE
(� S r &12e d PLUMBING
er �r"bl f(sloo rut). MECHANICAL
STATE BUILDING FEE J—
APPLICATION ACCEPTED BY I PLANS CHECK BY APPR D ISSUAN PERMIT VALIDATION
c � /�T BY Lt CASH CK MO TOTAL
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 YS- WIDTH /C7
MODEL
MAKE MODEL 0A2 YEAR /2 'f
MOBILE HOME LOCATION INFORMATION SERIAL # �-��7 6`7
A. My privately owned land yes no X_
OR
B . If rented or //lleased land who from? NAME6t&1,'G4WA—' �(J Jr AMA 65
ADDRESS � /TGr� ", Al. CITY & STATE
C . Real Property Parcel # i7') CCt� kr� J�'yt{� ( from tax
statement of new location )
D . Mailing name and address for owner of mobile home
NAME
ADDRESS F1`1C�`� (���_ti''i t' ` O, n �`, CITY & STATE Jt� tbtl
E . Location address of mobile home ,C /y(ir �,c�-�!1NS JI�DA/City S�EGTN
F . Date mobile home was
�cplaced on present site /10- Z - C'
G . Purchase Price
DATE 2 ' 5 2Z SIGNATURE
TYPE OR PRINT NAME
TELEPHONE NUMBER
41.1 N. 5th ___P.O. Box 'I - Shelton. Washinntnn 9A584 Phnno 074970
MASON COUNTY
427.9VO BUILDING DEPARTMEN Na
T
ALL PERSONS ARE HEREBY ORDERED TO AT ONCE
STOP WORK
ant ✓yD 61 t, , /
On these Premises at ................._. �- �"� ..
................................................................... ..... I...I.0............_............................................................................._.._....................__..
This order is issued because ........1.40.......... ..v..l l i..........�� t ...4................................................_.....
............................................................................................................................................................................................................._................_.....
Posted .1........ S. .....Z.....Z:-.�� ........................... 19.. l _ By ..`............................... _.. - .._..
WARNING The failure to stop work, the resuming of work without permission from the
Building Official, or the removal, mutilation, destruction or concealment of
this Notice is punishable by fine and imprisonment.
I
t
4e
I
.i�� •fi
S
COMPLAINT NO.:
DATE RECEIVED:
RECEIVED BY: t�-o
MASON COUNTY
COMPLAINT INVESTIGATION REPORT
Location/Address: Lg-A _ S
Directions to Site:
Complainant: Address: Phone:
Notify of Response Yes No
Agencies to be Contacted: WDOE WDOF WDW USACOE
SQUAXIN SKOKOMISH DOT DNR
DETAILS OF COMPLAINT:
l 4,C)
Ll
�7�
INVESTIGATION
Investigated by: Date of Investigation:
Details:
ACTION TAKEN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
Mason County Bldg. III 426 W.Cedar
P.O. Box 186 Shelton, Washington 98584
(206) 427-9670
building parks&recreation fair/convention center planning fire marshal
March 4, 1992
Mr. Rudy Shaw
E 140th Blevins Rd. N.
Shelton, Wa 98584 # 410
Mr. Shaw:
You are requested to pick up your permit for the mobile set-up at
the above address. Your promptness in this matter would be greatly
appreciated, before further action is required.
If you have any questions regarding this matter,please call this
office at 427-9670 Ext 359 .
pectf 1 ,
Rob r Lum
Building Inspector
Fold at line over top of envelope to the right
of the return
rpss
MASON COUNTY I
DEPARTMENT of GENERAL SERVICES CERTIFIED
u. U.S.PHIAGE
Mason County Bldg. III 426 W.Cedar MAR-,"92 %-;i/�
P.O. Box 1'89•w,� P 4 6 4 511 7 5 9 �. -' ` z` 2 .2 9
Shelton,Wasl4l'6 tan 98584 f
�a S , P.N. 811)3 �*
ho5a037
* ► tame .
MAIL
,�. MR. RUDY SHA�J
t� UJ Reiuriti
�'T Q E 140111 BLEVINS RD N. V
SHELTON WA 98584
b�q ��0
1
SENDER: I also wish to receive the
• Complete items 1 and/or 2 for additional services. following services (for an extra
• Complete items 3, and 4a & b.
• Print your name and address on the reverse of this form so fee):
that we can return this card to you. 1. ❑ Addressee's Address
• Attach :his form to the front of the mailpiece, or on the
N) back if space does not permit. 2, El Restricted Delivery
w •y Write "Return Receipt Requested" on the mailpiece next to 70
the article number. Consult postmaster for fee. S
4a. Article Number d
p 3. Article Addressed to: P 464 511 759
40 MR. RUDY SHAW
4b. Service Type 0 c
°C E 140TH BLEVINS RD N (#410) Registered El Insured
* 0
LU ° SHELTON, WA 98584 Certified ❑ COD C
o El Express Mail ❑ Return Receipt for CD H
� Merchandise ,
c m 7. Date of Delivery m t°
Ta
y E
5. Signature (Addressee) 8. Addressee's Address(Only if requested
and fee is paid)
6. Signature (Agent)
PS Form 3811, October 1990 *U.S.GPO;1990-273-661 DOMESTIC RETURN RECEIPT