HomeMy WebLinkAboutBLD29949 Mobile Home #413 - BLD Application - 2/18/1992 BUILDING PERFIT APPLICATION
j MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
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427-9670 DATE ISSUED
PERMIT NO. —
NAME MAILADDRESS CITY&STATE ZIP PHONE
OWNER /9•l/ n1 L /J G�-.�,
DIRECTIONS
TO JOB SITE v e C C /-z-
PARCEL LEGAL
NUMBER ESCR. I, Z� ► I f
NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR S ��
USE OF
BUILDING �'d�"' c 21
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK lyJ oJ/L Ua,-.L �- C/ t�
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE. �SgFt STORIES SHORELINE❑ CONDITIONING
BASEMENT SgFt BEDROOMS PRIMARY RES.❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS S Ft BATHROOMS SEASONAL RES.❑ COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
g ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED O DETACHED Cl
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.
X OWNER DATE X BY DATE_
FOR OFFICE USE ONLY 01 �
DEPARTMENT YESPPRovENo DEPARTMENT YESPPROVENO BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
zf
PLANNING � , FIRE MARSHAL BUILDING PERMIT --
D.O.T. BUILDING - PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLI ATION ACCEPTED BY J'PLANSCHECIK APP D F ISSU C RMIT VALIDATION
y` TOTAL
BY CAS CK MO L
1 -
s the
r 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 J.S ' WIDTH d
^^// MODEL
MAKE�yA MODEL S 5^ U YEAR
MOBILE HOME LOCATION INFORMATION SERIAL # C/s U G/C yap/
A . My privately owned land yes no G
OR
B . If rented or leased land who from? NAME l
ADDRESS :// CITY & STATE S /,4 .
C . Real Property Parcel # ( from tax
statement of new location )
D . Mailing name and address for owner of mobile home
NAME
ADDRESS CITY & STATE
E . Location address of mobile home / 9?,�—/ _ City
F . Date mobile home was placed on present site ''90 `J'
G . Purchase Price "np , c�
DATE �— 3 1`- J SIGNATURE
TYPE OR PRINT NAME
TELEPHONE NUMBER G/vZ1 7 % S _1
411 N. 5th P.O. Box J Shelton, Washington 98584 Phone 427-9670
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� January 22, 1992
To Whom It May Concern:
�
Space #4- at Evergreen Mobile Estates has been rented &
paid for by Don Hawkes.
Ev��green Mobile Estates Manajer '