HomeMy WebLinkAboutBLD26054 Mobile Home - BLD Permit / Conditions - 5/24/1990 W&NDING PERMIT APPLICATION
MASON COUNTY
APR 18 1990 DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
uENERALSERVICES 427-9670 DATE ISSUEZ-10
PERMIT NO.
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
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DIRECTIONS
TO JOB SITE S7; per! t
5
PARCEL LEGAL
NUMBER 6�p /9 DESCR. fJ/D/7-C /L? � [,�7�1/�it�iP �X�CI•
NAME MAIL ADDRESS CITY&STA E LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF 2
BUILDING Rjf,511).
CLASS
WORK Or NEW ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE
WORK
OD
O x J13 14 li 5 %
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 SO.FT. FI REPLACE 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 1 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 F M THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO Q
HEALTH PUBLIC WORKS FEE
PLANNING �, FIRE BUILDING PERMIT _
D.O.T. BUILDING PLAN CHECK '
SPECIAL CONDITIONS BUILDING GROUP � PRE.INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATESURCHARGE
APPLICATION ACCEPTED BY PLANS CHrEC1K BCY� PERMIT VALIDATION
S 7F��UANCE
CASH CK MO TOTAL �J
PLOT PLAN
ADDRESS PERMIT NO. C c
i
w >
LEGAL
DESCRIPTION LOT 9 112 BLK / �? ADDITION 6/, Cf 2, /e,
SITE AREA��6960 Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS SSV Sq. Ft.
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"-20' ARE
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.)
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN-
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION AND SEWER SERVICE ELEVATION. SH �W LOCATION OF WATER, SEWER, GAS AND ELECTRICAL
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
I�
J
-T
I/We certify that the proposed construction will conform t e dimensions and ufef glnwn above and that no changes will be made without
c U
firrt obtaining approval. . - C
J
NAME(S) OF OW ERlfl OF SITE & STRUCTURE(S) (PRINT) IGN TU OF N 131 OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
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 SS WIDTH
MAKE k1 c MODEL YEAR
MOBILE HOME LOCATION INFORMATION SERIAL ff/--1 77
A. My privately owned land. YES NO B. If rented or leased land who from? NAME
ADDRESS S7; CITY A STATE 4/� //, wiQ.
C. Real Property Parcel J# (tax statement #)
D. Hailing name and address for owner of mobile home
NAME 4�Z � ,a1g;04 C,
ADDRESS CITY 6 STATE ,j/'j�j�,
E. Location address of mobile home :i�.V_�ex gr CITY_T/aj
F. Date mobile home was placed on present site
or
C. Purchase Pric�DDD. d O
DATE: SIGNATURE
TYPE OR PRINT NAME_
TELEPHONE NUMBER ��—����
Courthouse Shelton, Washington 98584 Phone 427-9670