HomeMy WebLinkAboutBLD29859 Mobile Home - BLD Application - 1/28/1992 c1. - 7&
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED /(��`p�6 ,/��'C-���
PERMIT NO.�/ D
NAME I �:�l-AIL ADDRESS CITY&STATE ZIP PHONE,' o
OWNER ! v)' . eAfl) s F � �� , ;2 �3-S✓�.
DIRECTIONS 1�
TO JOB SITE -. t4 LiJI 1. -1�1 �..� ' U N OLD _OIJ,0_ %"b'LGli4 j
PARCEL j x? / LEGAL
NUMBER DESCR. / ig
NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR .
USE OF
BUILDING Q m
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK
DESCRIBE
WORK
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS L PRIMARY RES.❑ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS $ Ft BATHROOMS L SEASONAL RES. COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
g ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED O DETACHED❑
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
1 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 _ _ X BY [�ti DATE /2 _3 q/
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION 7 /�
YES NO YES NO
HEALT PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT 6t_ ZS
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
g?lz'cj - h SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE L} 5-L
APPLI TTION CCEPTED BY PLANS CHECK BY APPROV 1, SUANCE PERMIT VALIDATION
'� J� IBY ! CASH CK MO TOTAL '93
75
BUILDING PERMIT PLOT PLAN
MASON COUNTY
OEFAFtT' EN I of GENERAL SCRVIC_�
F.Q. pax 1 Sc SHELTON, Wl-'NSHINC TON SaScc
r vc.
T `, �,.., f nor :+
V0 2�k2`l4 �'�� � W a SN10�i
cC c cvs ! You-CP-fir 1��4�52 QC�Jr� Ott Rey�o-i r �►J �pur C�r�J
on J-7\ 2 vJ
tD3ac1 i3 L,�:
O Easem2n,5 Z C' raaC'S
O 52^tiC, drzinfi2ld cr d reS2rve 2r2- Cr 521N-�r.
_ C 5e-tic tzr.ic znd drzirfield szttzc:<�is:znces [ran fca::dz6zns.
S C Lac_ticn of prapased cons ruction or, prap2ry.
Q Euildi:9 & Septic SI S;'_r„ 52ttzck CIS:cRC_S fra'rZ a!I prp2ry Cr,2S e_sem.ents.
indicate Nar;h O WeII and wzter Gne.
Q 5�(i.`�c�?r, Izkes, rivers, Sti2ams,Wetlzrds, dfa:nc�e.
In Circle O A.:,zch caey of septic system`as bu:1; or septic perm..it-appr.:vZL
- O Inc5czte tapasrzp-hy prarile of property and S;.scture Cr: reverse S:de.
5011 J
I I I I I I I I I I I401 T
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I I I I I I I I I I I I I I I
I I I I I I I I I ( I I I II II ( I I I I I I
I I I I I I I I I I I I
II
I I I I I I ! I I I I I I I I I I I I I I I I I I I
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 At/e WIDTH
MODEL
6
MAKE G"�-�G�t.� (,c/�r i� MODEL 13 D Ir- , YEAR
MOBILE HOME LOCATION INFORMATION SEERRIAL #
A . My privately owned land yes no
OR
B . If rented or leased land who from? NAME /
ADDRESS /1///4 I // 0&A .3641=-ii4 11WY CITY & STATE���G/''��� G(1�
C . Real Property Parcel # 4),3V— /3 _ Z96 ( from tax
statement of new location )
D . Mailing name and address for owner of mobile home
NAME /C T�
ADDRESS pd.Q0n'of 7' Y CITY & STATE3F.c)F'0!91/J--- 6 at
E . Location address of mobile home�61// 0Z/3 J4)C)I ty 3&4�
F . Date mobile home was placed on_present site
G . Purchase Price
DATE �� '3 !_ �/ SIGNATURE t
TYPE OR PRINT NAME e4L,16 %,C 06 (_
TELEPHONE NUMBER
411 N. 5th P.O. Box J Shelton, Washington 98584 Phone 427-9670