HomeMy WebLinkAboutBLD30143 Move Mobile Home - BLD Application - 3/26/1992 BUILDING PERMIT APPLICATION
� MASON COUNTY
5'GU DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON, WASHINGTON 98584 ��
427 9670 �F)0'6 DATE ISSUED ' f
/s-
PERMIT NO.
E OWNER MAILADORESS CITY&STATE _ ZIP PHONE !
/ )
DIRECTIONS
TO JOB SITELp (�
PARCEL i Z 3 y� �.� LEGAL
NUMBER � DESCR. 4f1 )4w/ /
M� MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR `f/Ud
A o-y
USE OF
BUILDING -- LJp 11/1 bil-z-
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE 1
WORK
oq x3 Z 7 0
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
X•j SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE ZSgFt STORIES_� SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS 2 PRIMARY RESjN THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS $ Ft BATHROOMS COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
q SEASONAL RES.❑ 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
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 E MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM T E BUILDING DEPARTMENT APPROVAL FROM THE BUILDING DEPARTMENT,
X OWNE t'Y ,vz-ILL E _ X BY DATE —
y`�`' FOR OFFICE USE ONLY
APPROVED APPROVED 6 c I
DEPARTMEN ves No DEPARTMENT YES No BUILDING VALUATION �'�c� -- V
HEALTH J� PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT 2-2-ZS
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
< SHORELINE
W d S f WOODSTOVE
I l hh?M 10 5 ' 4 NA VPLUMBING
Y �O 4 W 1 011 NW6A_ MECHANICAL
Aame-nC Qr STATE BUILDING FEE
imp
APPLICATION ACCEPTED BY PLANSCHEC"Y VE O SUANCE PER MIT VALIDATION
B -- CASH CK MO TOTAL �Le-�
L —,f—)
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 OATS!sSUED
PERMIT NO.
NAM MAILA00RESS C1i 3 STATE ZIP PHONE
OWNER > v�`141
qt 75
OIRECTICNS
TC JOB WE I L
�Zi. ,1` Z
PARCEL uLEGAL
NUMBED I� 3 �!` ��� ,�I OESCR.
Indicate below: ¢t Property lines and dimensions.
Easements and roads.
Septic, drainfield and reserve area. o(sew_ar,,
q- Septic tank and drainfield setback distances from foundations.
')Q Location of proposed construction on property.
�f& Building & septic system setback distances from all property lines& easements.
Indicate North Qr Well and water line.
tV Saltwater, lakes, rivers, streams, wetlands,drainage. crL r
In Circle _�---
Attach copy of septic system "as built orseptic oerml 'approval. '
!a Indicate topography profile of property and structure an reverse side.
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Vie car; (..^.3(:i1d (C. Ji2'cCnS:. CJCn•n. Cr' .
. _ 3nC u52i 3CCve 3���mar.-to C`3'y 35 Hill:.e :�b(3irtins 37vrJval-
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TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
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Plat Vol. e'G. Order No.
SKETCH OF PROPERTY SET UT IN ATTACHED ORDER
To assist in locating the premises. It is not based on a survey, and the company
assumes no liability for variations, if any, ih dimensions and location.
M N 47S.-TO
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Jtil3 � �`2 i 1 w
° S� � ` .� a o t 82-7204
qj (1�.500°') c 0 Om K 1-�I LL) 4
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� GA 000°'sn r , _��5.16. 'r — 15.00 �` (ovcr►) C OR 1.514 GG.
o- 1 rY,�.S - ---- ... -�
Q , re•1q.. �'aa'yv 67.4! ,1" r 57.58'
(� 4O war
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`� EXIgT1NG� IVS �-0 Q (f�,500b 0 � � ` p
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501.30'
137.00' No LINS
�►� - - 563 .30- - OLAT
SB6.S (PLAT) _ _
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Note—This map does not purport to show all highways, roads or easements affecting the property.
i
the
Y 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 j WIDTH
MODEL
MAKE l MODEL IIIZJIM YEAR ZZZe)
MOBILE HOM LOCATION INFORMATION SERIAL #
A . My privately owned land yes no_��
OR
B . If rented or leased land who from? NAME
1
ADDRESS PO 80x ':;?'91 27- YWS-CITY & STATE 1.
C . Real Property Parcel # 5y. �Da7v ( from tax
statement of new location )
D . Mailing namZan address for owner of mobile home
NAME O a
ADDRESS 12alCITY & STATE o
E . Location address of mobile home 1 City
F . Date mobile home was placed on present site
G . Purchase Price . �pcx>yG
DATE SIGNATURE Gl�
TYPE OR PRINT NAME Jal;ll�1-1 Ll all
TELEPHONE NUMBER c727�
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411 N. 5th P.O. Box J Shelton. Washinntnn g8584 Phnne 4P7-qf;70