HomeMy WebLinkAboutBLD N/A Cancelled Mobile Home - BLD Application - 2/3/1991 .e® ako BUILDING PERMIT APPLICATION
r, '114uJ MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-967�,y 0 DATE ISSUED
f"� 0 il- ,-"& PERMIT NO.
NAME MAILADDRESS CITY 8 STATE ZIP PHONE
OWNER U� y / _
DIRECTIONS
TO JOB SITE
,y ��, 4 GL Et �/A — ��
PARCEL !� 3Gso LEGAL '/
NUMBER DESCR. «�
NAME MAIL A SS A _5/4,ArLICENSE N ZIP PHONE
CONTRACTORUSE OF
BUILDING
CLASS OF W ADDITION ALTE ATION REPAIR MOVE REMOVE
WORK
WORK DESCRIBE Oi/
BEDROOMS_ DECKS CAR ORT NOTICE
SEPARATE PERMITS E REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. /2,2. GARA E CONDITIONING.
NO.OF STORIES BASEMENT 62, ATTACH D W THIS PERMIT BEOKMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTALSQ.FT. FIREPLACE O DETACHE � ABANDONED FORA PERIODOF180 DAYS AT ANYTIME AFTER WORK ISCOMMENCED.
PERMANENT SHORELINE
SEASONAL
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 OWN ER �� ` E ._ - �j XBY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES No
O DEPARTMENT YES
APPROVEDO BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP `{-3 PRE-INSPECTION
J SHORELINE
WOODSTOVE
yX46 x PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
IBY�)1,3-Y-�'[ CASH CK MO TOTAL '3
it
S. Gordon Craig
.., .� the
.rnasan sty
assessor
Dear
We have recancly received a copy of tax certificate for mobile home
movement on your mobile home.
In order chat we may accurately value you mobile home, please complete
the questions below and return this form to our office by
It is imperative that this information be provided co prevent a
possible double assessment.
MOB= HOME DATA LOCH ii IDtS
MAKZ '��7 X�e
MOBILE HOME LOCATION INFORMATION SMAL �
A- My privately owned land. YXS so�
B. If 70ed or leased land wbo from? d,1 NAME'2 ;41
/,� �C �A e--33�12 Z cm & sZ►rg�/�y/iyw/�9��2
C. Real P rope rty Parcel (tax statement )
D- Mailing name and a/d/dress for owner
ow of mobile base
NAME
ADDRESS ??' Z Z��'Z�/1`U�-S/� 6 STA M � ('14 z �
E. Location address of mobile home/L61s1/"'ea CM
F. Dace mobile how as placed on present site
C. Purchase Price C�
^��DAZE. SIGNATURE �!
TYPE OR PRINT NAHH
TELEPHONE NUMBER ��,y-
Courthouse Shelton,Washington 98U4 Phone 427-9670