HomeMy WebLinkAboutBLD N/A Mobile Home - BLD Application - 11/18/1991 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& T E ZIP PHONE
c A� I ► R�, >>o a�
OWNER v�q 9`55Lb 2 s- c�
DIRECTIONS
TO JOB SITE Irl
PARCEL 12 ,3 ZZ` - - LEGAL
NUMBER 10 2 e) DESCR.
NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR
USE OF
BUILDING mQ �OrYI�
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE I I c e- mn bile. �e � k
WORK I ' ` O ,,Qe_A Gn L0cl
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE SgFt STORIES SHORELINE 0 CONDITIONING.
BASEMENT_ SgFt BEDROOMS 2 PRIMARY RESk THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
DECKS _��SgFt BATHROOMS I SEASONAL RES.❑ ABANDONED FORA PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
CARPORT_ SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE_ I0 SgFt ATTACHED 0 DETACHED❑
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.
i J I
X OWNER (Sl `'D s c7 DATE !/-'�- J L X BY _-----DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
na�n ?, SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY i PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
BY CASH CK MO
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
F.O. Sc-, 186 SHEi TON, WASHING TON SaS8e-
N::.SC L1�iL n1JCfY�-s � (v S E P P Ci�11E.
OWNEF INCYI-1191y s,r7 P/ 2 I L //t' Wig V-j
319 -Y.?-qo
Ind;Cz:e =eic�.. r rroY,r. �,•." ' �-: C; -,e, s -. ..
r
O E?serren,s and roads
O Septic, dratnfield and reserve are;—: or sawer.
O Septic tank and drzinfield sattack his:ances from `Cur.dat;Cns.
O Location of proposed eonstruCtior, an proparI;.
O 06uny 3 septic system set5ack distances from all prcper`,y liras � easer;ents.
Indicate North O Well and water line. _
O Sal�.vater, lakes, rivers, str earls,wetlands, drainage.
in Circle O A%ach Copy of septic syst2rl was built" or septic permit approval.
O Indicate topography prcFle of property and structure on reverse side.
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the
1
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
MAKEIC)r1cjr,�Ka MODEL YEAR �q�3
MOBILE HOME LOCATION INFORMATION SERIAL # 295�(OSS33Z.S
A. My privately owned land yes no
OR
B . If rented or leased land who from? NAME �op.ma� r. JeY1Sen
ADDRESS Urlknotk)(\ CJ A)S 1, t"�e. CITY S STATE &I}AI'p, uoct ,
C . Real Property Parcel # )23Z."1 L{ "7-, `i00'7O ( from tax
statement of new location )
D . Mailing name and address for owner of mobile home
NAME Cr�nIC
ADDRESS PC) , �� ���- CITY & STATE BJrh)k— Wq .
E . Location address of mobi le home 1+ -EV) Roe.55ej �,� City 60A)R,
F . Date mobile home was/laced on present site
G . Purchase Price C, c)oo o0
0 D
DATE 11��8 ``�� SIGNATURE
TYPE OR PRINT NAME CRAIQ 1✓, ell15
TELEPHONE NUMBER Z?S- `1`f �`t
__ 41.1_N. 5th P.O. Box J Shelton. Washinntnn gA5A4 Phnnc d07_oA70