HomeMy WebLinkAboutBLD92-0046 Mobile Home - BLD Application - 4/14/1992 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.
AME _ MAILADDRESS CITY&STATE ZIP PHONE
OWNER 6c;aeErV {7 LAST 1 1 SqcobrQ i 4TtC o& MfLTON q26 -
DIRECTIONS LL /' ,I
TO JOB SITE ril ( CST Or oIJ Si+-LTON /TAT /?0�, lJ 63 lb5`6'1
PARCEL ���) , � G`� � LEGAL]
n Q ,
NUMBER IQ , d S�° �� J7 W �� 17-��-
NAME MAIL ADDRESS CITY&STATE ZIP �� �'y PHONE LICENSE NO.
CONTRACTOR ti•)i- 2 ) sbw4 iJ '/Qc 7sLe Z
USE OF
BUILDING ✓` S /!>!a A.;
CLASS OF NEW X [ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE
WORK �'� /f�GL L' j3/L h' e C••✓ dLl f'�J�
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE ( 7 Sq Ft STORIES 1- SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS j PRIMARY RES.8 THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
DECKS SgFt BATHROOMS _�_ SEASONAL RES.❑ ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED Q DETACHED❑
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.
XOWNER ^' L4,etcgATE XBY ? DATE
FOR OFFICE USE ONLY <<
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING '�'�� Z` PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUPS PRE-INSPECTION
r SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
�L7ATIO A/C�CEPTED BY PLA S CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
_/ ( � BY CASH CK MO TOTAL
•
• . D.-
•
PARCEL
NUMBER
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TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
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 WIDTH --3L6 -
MODEL
MAKE MODEL 7f YEAR
f MOBILE HOME LOCATION INFORMATION SERIAL # '�.�t-r- �)ET IbAiCXjhj
A . My privately owned land yes no
OR
B . If rented or leased land who from? NAME
f ADDRESS CITY & STATE
k
C . Real Property Parcel 1?004� ( from tax
[: statement of new location )
D . Mailing name and address for owner of mobile home
NAMEAL
ADDRESS 1, ��.`?) ) S0CLTCitJ N14TWK Pd- CITY & STATE 9trCTOkI UA
E . Location address of mobile home City
F . Date mobile home was placed on present site I'VC; �tr
G . Purchase PricelfZ)4nc y)
DATE_'j f•7 / Y }• SIGNATURE_
TYPE OR PRINT NAME F31f-LS-7'AiO
TELEPHONE NUMBER