HomeMy WebLinkAboutBLD N/A Cancelled Deliver and Set Up Mobile Home - BLD Application - 12/9/1992 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.
NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
OWNER earra f Les Ile Wi,i f e o A&
DIRECTIONS
TO JOB SITE T e- 'r iLh`qi—r7
a l4 e 'r< ,S ,a -e lk Alt,le- 00 k e t(
PARCEL If
C LEGAL qT G�/L lug Y 1/ — .I� '/
NUMBER iZ3��'ylCl" a�.j`�`{� DESCR. I�Q� IV
NAME MAIL ADDRESS CITY 3 STATE ZIP PHONE � Y-� VS- LICENSE NO.
CONTRACTOR l pM S S , 4E'1Le AcAL !iwl- Sov tysAkAn AJA ITf
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION AIR MOVE REMOVE
WORK r
DESCRIBE
WORK ✓Pr v mek,'Af X 6 Goy t°c )�•�
r ,h
AREA: NUMBER OF: PLEASE INDICATE: N
SEP RATE PERMITS RE�REfflRD'FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE / SgFt STORIES / SHORELINE 0 CON TIO ING.
BASEMENT SgFt BEDROOMS P IMARY RESA TFNEDF
MIT EC M N LL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS S Ft BATHROOMS L' EASON L RES. ED IT I AYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
g A PERI D 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE I CARPORT/GARA E
GARAGE SgFt A CHED❑DETAC D
OWNERSAFFIDAVIT CONTR TORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF TH "CTORS 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 DATE _ XBY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION 1
YES NO YES NO �
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT /
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDINGGROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE `�
APP ATION A CEPTE BY PLANS CHECK BY APB ED ISSUAN E PERMIT VALIDATION
, SH CK MO TOTAL //
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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 .
MOBILE HOME DATA LENGTH � � WIDTH - '
# -1.4 MODEL
MAKE jjfttWOnA MODEL YEAR /I/�� /
MOBILE HOME LOCATION INFORMATION SERIAL #
A . My privately owned land yes no
OR //
B . If rented or leased land who from? NAMEA,4 :T //� (Qlla�A,-
ADDRESS NA� /?1 CITY & STATE 9"Air, A14
C . Real Property Parcel 1-0 -/c ( from tax
statement of new location )
D . Mailing name and address for owner of mobile home
NAME l�jk(r /j I i e Gt/h, JP
ADDRESS �!�' �E_ /°Iv1�0� ��r�`��� CITY & STATE
E . Location address of mobile home ket City �<
F . Date mobile home was placed on present site
G . Purchase Price
DATE SIGNATURE
TYPE OR PRINT NAME
TELEPHONE NUMBER
411 N. 5th P.O. Box J Shelton, Washington 98584 Phone 427-9670
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
Mason County Bldg. III 426 W.Cedar
P.O.Box 186 Shelton,Washington 98584
(206)427-9670
BUILDING PARKS& RECREATION FAIR/CONVENTION CENTER ADMINISTRATION
November 18, 1992
Carroll White
160 NE Anchor Drive
Belfair, WA 98528
To Whom It May Concern:
Your building permit was approved by this department over 6 months ago. It is our policy
to hold the permit for a six month period before the permit is no longer valid. Please
indicate below your intentions regarding your building permit and mail it back to us. If
I do not hear from you within two weeks from the date of this letter I will assume that you
want your permit canceled and I will bill you for any plan check fees that apply to the
permit.
I will be in within the next 2 weeks to get my permit.
If I cannot pick it up, I will notify you.
Project: Mobile 4 e r1�C
Amount Due: I I a- �
I wish to cancel my permit.
realized I will be charged for any plan check fees.
Plan check amount due:
If you have any questions regarding this matter or you feel there is an error please feel free
to call me at 1-800-562-5628 or 427-9670, extension 207.
Sincerely,
Desi King
Building Clerk