HomeMy WebLinkAboutBLD29615 Mobile Home - BLD Application - 11/27/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED
�,+a PERMIT NO.� 1 ('lam`
OWNER NAME _ I MAIL ADDRESS CITY& TAT ZIP PHONE
I da k���an.1 s I- - 4 i),'u, t t�v 0:� yZ - ZS�o
DIRECTIONS
TO JOB SITE ,+ (y Alevu b4-
PARCEL yGn. LEGAL �+ 37 /�,�,
NUMBER ZC 2-e 73- DESCR. /
NAME MA DDRESS CITY&STATE',/� ZIP PHONE LICENSE NO.
CONTRACTOR l-`�l'.S �eA,. u L d �/9 G(�`otr %F'%fo S3 J- � - LSC,,,v Z 077M L
USE OF /
BUILDING e 19,7-Jae 2 J�- -0
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE v
WORK /(r ,(°/ /t/ GCS -Z y0 1,C1,e e Xxloo /
001tJ416 C�4 — 0 cU pt/S r c c✓
L � S �;'{„�K/' %.���x Gl/tt- -- �orc. ��✓�✓,'�%oyt. �. l :s� %f'�/��/�r1
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 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
g ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME 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 FO ICH THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFOR ANC THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROV F T G
X OWNER DATE X BY 7_7,�DATE
FOR OFFICE USE O N&
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION
YES NO YES NO -� _D
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT 'V
D.O.T. BUILDING PLAN CHECK Zlj�
SPECIAL CONDITIONS BUILDING GROUP 3 Q PRE-INSPECTION
AD2Z� SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE So
APPL91C�AT}IO A EPT50 BY PUN CHEC BY APPROVED FOR ISSUANCE EA�NCE PERMIT VALIDATION
BY CASH CK MO TOTAL
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10.0 64 1.3 1.6 4.0 1.3 1.6 L-5 -2.1 2.4 g-5 3 a r72 -E ; g 17.2 4 4.7
i 10.5 6.1 1.3 1.6 4.0 1.9 1.6 i 9.5 2.2 1T.1 3 7 4.0 1 7 1 A. 4.9
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12.0 1 5.3 1.6 1.9 4.0 1.6 1.9 8-5 1 2.2 2.5 &5 I 2.7 1 4.0 16.0 1 4.2 4.E
FRMSTAHDING STRUCTURE
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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 . �y
MOBILE HOME DATA LENGTH !f0 WIDTH b
—� C MODEL F�cc�wop�
MAKE MODEL WO L^ YEAR /491
MOBILE HOME LOCATION INFORMATION SERIAL # U N k �
A. My privately owned land yes no
OR
B . If rented or leased land who from? NAME `
ADDRESS �R'3Z / 4e-cu J>0. S�, / 7OAJ CITY S STATE w,as
C . Real Property Parcel # ( from tax
statement of new location )
D . Mailing name and address for owner of mobile home
NAME Gd p.+c,,- w'C(RN S
ADDRESS SF- �S'2 " AKc�-� i� J;Le ["CITY & STATE
I
E . Location address of mobile home Sa-rh -e City
F . Date mobile home was placed on present site // IS `SSII
G . Purchase Price-"3o �`1Z-,�,rs�
DATE 10` 7,1 -91 SIGNATURE
TYPE OR PRINT NAMES /���l•UNS�'' n(
TELEPHONE NUMBER yZ�o ` ZS`30
__ _ 411 N. Sth P.O. Box 4haltnn Wachinntnn 4A5Ad Phnna A07_na,11 J