HomeMy WebLinkAboutBLD92-0110 Mobile Home #24 - BLD Permit / Conditions - 10/17/1994 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O, Box 186 Shelton, Washington 98584
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BUILDING PERMIT APPLICATION ��69- 006
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
IJ QG � Z L 427.9670 DATE ISSUED
4 P5 s j OVA C� 0 At/ PERMIT NO.
NAME MAIL ADDRESS CITY S STIATE ZIP
OWNER rl C1
DIRECTIONS �� 1 /►1
TO JOB SITE �
�
NUMB �� 5o LEGAL
NUMBER DESCR.
NAME MAIL ADDRESS CITY d STATE ZIP PHONE LK;EN9E NO.I
CONTRACTOR f lont r �Q �,X 7E?9 �'a,tsTz�e M92 37 9— 5�-
-'USE OF
BUILDING
C WORK LASS OF NEW I/ ADDITION ALTERATION REPAIR MOVE REMOVE
r
DESCRIBE
WORK � .' o ►3 td-ewJ A& ,Q
ILI
G- -- -- -AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING. HEATING, VENTILATING OR AIR
RESIDENCE t#LSqFi STORIES SHORELINE U CONDITIONING
BASEMENT SgFt BEDROOMS �_ PRIMARY RESX THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS SgFt BATHROOMS L_ SEASONAL RES.p COMMENCED WITHIN 180 JAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED D DETACHED U
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 OWNE _DATE L _ rZ X B — - --- DATE-� --
FOR OFFICE USE ONLY
APPROVED APPROVED
DEPARTMENT YES No DEPARTMENT YES No BUILDING VALUATION `j
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
�G) SHORELINE
-7� WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE J
APPLICATION ACCEPTED BY �/S CHECK BY APP ED F R ISSU NCE PERMIT VALIDATION f�
KGK TOTAL�{ �/. BY CASH CK MO
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
r dAA IV'`(1 M S A// ERMIT NO.
NAME MAIL ADDRESS 0 f Y8STATE ZIP PHONE
OWNER
DIRECTIONS
TO JOB SITE
PARCEL LEGAL
NUMBER 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.
1� 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.
C r' 7
M°8
y
I/We c rtify that the proposed construction will conform to the dimensions ar d uses shown above and that nd changes will be made without first obtaining a proval.
I ATURE OF NER(S)OR AUTHORIZED REPRESENTATIVE
DO NOT WPITE BELOW THIS LINE
APPROVED
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 �.
MODEL
MAKE M0DELZd -cL YEAR
MOBILE HOME LOCATION INFORMATION SERIAL #<
A . My privately owned land yes no
OR �g
B . If rented or leased land who from? NAMEC-->_,1,1eW
ADDRESS 'C �;1_D �.Nt<c• � Kc� CITY & STATE
C . Real Property Parcel #t � 0�3�� 61) 01)0Q) ( from tax
statement of new location )
D . Mailing name and address for owner of mobile home
NAME /✓r.en m Z_,2TA,4 ek
PO LLI U
ADDRESS >s CITY 8 STATE �- 'W
NcltJr'/ySG�.le f,E.�Er
E . Location address of mobi le home c:as'; Gv? ye;-3 7 City
F . Date mobile home was placed on present site ��i9 S�
G . Purchase Price
DATE 4L//0 ,2- SIGNATURE I
TYPE OR PRINT NAME SAcrEIt2 cv
TELEPHONE NUMBER Z&L- ) V 7f_ 7V7V—
GOLDEN BELL MOBILE HOME PARK
I. Earl Hinde, Owner of the Golden Bell Mobile Home Park
•and '�� err, o( �nZ_, -have agreed to a rental
agreement pertaining to Space , an existing Space of
the Golden Bell Mobile Home Park. This agreement is in
effect upon issue of a building permit .
THANK YOU
1 �it,u 1c plc.