HomeMy WebLinkAboutBLD30909 Mobile Home - BLD Application - 7/20/1992 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED I
L q9
PERMIT NO. q
OWNER NAME MAILADDRESS CITY&STATE ZIP PONK
r�. o E ' ! _ µ 7 -
DIRECTIONS TO JOB SITE _1090T17 F10OA41 fFlfj41t0 01/0 e(/ /� fi'W ,l°I`/
's- h IF 04 rO 4 P' q Y14 �O
PARCEL LEGAL
NUMBER 23/L Z Z. 90 it 3 DESCR.
CONTRACTOR
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
USE OF
BUILDING L s
CLASS OF WORK NEW ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE
WORK 60 K
/Z s
BEDROOMS �- DECKS _ CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SO.FT. GARAGE CONDITIONING.
NO.OF STORIES I BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
TOTAL SO.FT. 720 FIREPLACE COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT y SHORELINE
SEASONAL
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 ��-9 X BY _ DATE
FOR OFFICE USE ONLY �J
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION J
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT `,
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP ' PRE.INSPECTION
SHORELINE
:Z 4-f (� `,� i (l �� L\ T �v_ WOODSTOVE
OIVC, O "J - V\C)*&F Pt.Lt kz 'J 04-1 PLUMBING
cl
1'1Z� Q CAt N'OcT MECHANICAL
STATE BUILDING FEE _7
STATE SURCHARGE
.ICATION ACCEPTED BY PLANS CHECK BY APR ZV7E7�R IS U NICEPERMIT VALIDATION
/ CASH CK MO TOTAL >
S. Gordon Craig
1 ♦ the
assessor
Daa r
we have recently recaived a copy of tax certificate for mobile home
movement on your mobile home_
In order Char- we m.sy accurately value you mobile home, please complete
the questions below and recur= this fora to our office by
Ic is isaperacive that this information be provided to prevent, a
possible double assessment_
MOBIL HCME DATA
MA X!lr- PiLTlyo R4 jMnja 196
MCIS= HCHE LCCx^Dx rNfrRrA=Mf S�LII. 53E7.5S ,2 7-'1,--'
A— Ely privateLy owned Land_ TLS
E_ If tented or leased Land wbo from? IIAlSE �/ Ohh ��Y
ADDRWS /�V szJ►zt �'�Fs���°? uJrg,
C_ Real P roQe c-ty Pa ree 1 (tax statement #) 1 ?,3 J 6 Z 9 Q
D, !fa
i
ling /name and address for owner of mobile bone
co s f 13 a x l k0.2 C=-C MTE_
E_ Location address of moblle hoau �a re fp kd, CM
OF 14
F_ Dace mobiic home was placed on present site
C_ Purchase Pricc
DATE: C7 -/ 9 9 s IC.`tATUHE
I fPE a8 PRZHT YA2lE
T-rJ-Z?'ICHE H�Eg � y79-0 79L5
C.;urtneuse Shelton, Wasningtan 98S84 Phone 427-9670
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS CITY&STATE ZIP �}ip�E
OWNER
DIRECTIONS
TO JOB SITE AIJ Y`)
1/ flew i, 1,zr air �!�`/ zc, 51< /fir
PARCEL LEGAL
NUMBER d DESCR.
Indicate below; O Property lines and dimensions.
O Easements and roads.
O Septic, drainfield and reserve area, or sewer.
O Septic tank and drainfield setback distances from foundations.
O Location of proposed construction on property.
O Building & septic system setback distances from all property lines & easements.
Indicate North O Well and water line.
In Circle O Saltwater, lakes, rivers, streams, wetlands, drainage.
O Attach copy of septic system as built' or septic permit approval.
O Indicate topography profile of property and structure on reverse side.
r.V
` 5 "
t
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without first obtaining approval.
SIGNATURE OF OW ER(S)OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE '