The URL can be used to link to this page

Home My WebLink AboutBLD0359 Move Mobile Home - BLD Application - 4/2/1991 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. NAME MAILADDRESS CITY BSTATE ZIP PHONE OWNER _ �9 4 DIRECTIONS TO JOB SITE s - L c-,, L E PARCEL L LEGAL /`// c, NUMBER Q -O4e DESCR. L U T /�S� ,QeA 5 je' 1 0 L� a j NAME MAIL ADDRESS CITY 6 STATE LICENSE NO. ZIP PHONE CONTRACTOR USE BUILDING � CLASS OF NEW ADDITION ALTERATION REPAIR MOVE ,/ REMOVE WORK ✓ DESCRIBE WORK p /-f G D /3/ L = O / L BEDROOMS — DECKS YOR N CARPORT NOTICE TOTAL SQ.FT. DECK SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR S BATHROOM — TOTAL SO.FT. TOTAL GARAGE SEPARATE FT. CONDITIONING. NO.OF STORIES BASEMENT Y OR N THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT LIVING AREA ,/ BASEMENT COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTAL SO.FT. Z�_ TOTAL SO.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED. PERMANENTS FIREPLACE ATTACHED SEASONAL SHORELINE 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 ROVAL FROM THE BUILDING DEPAR ENT. \ Q APPROVAL FROM THE BUILDING DEPARTMENT. XOWNER ATE 1 L� XBY DATE FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION XZ � YES NO YES NO HEALTH PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT D.O.T. BUILDING RLPLAN CHECK SPECIAL CONDITIONS BUILDING GROUP I PRE-INSPECTION SHORELINE WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE STATE SURCHARGE APPLICATION ACCEPTED BY PLANS CHECK BY - � `R �FOR�,SSUANCE PERMIT VALIDATION W` C B CASH CK MO TOTAL _ PO. E%x 7114 OFFLUk I Z UVIQ,PLOT PLAN V. ` 3 � �fo� 5 ADDRESS 1�/ • L.•�• � �e^'�� PERMIT NO. o w s LEGAL C DESCRIPTION LOT BLK ADDITION SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS I O Sq.Ft. INSTRUCTIONS TO APPLICANT THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"-20' ARE FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- SIONS. SHOW EASEMENTS, FINISH CONTOURS OR ORlkINAGE, FIRST FLOOR ELEVATION, STREET ELEVA- TION AND SEWER SERVICE ELEVATION. SH'�W LOCATION OF WATER, SEWER, GAS AND ELECTRICAL SERVICE LINES.SHOW LOCATION OF SURVEY PINS. ECIFY THE USE OF EACH BUILDING AND MAJOR POR- TION THEREOF. z J�J� INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' Lit"k s � I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without first obtaining approval. 1.4 V' u 00 bofIG NAME(S) OF O N[Rlal OF SITE If STRUCTURE(S) (PRINT) IGNATUR OF OWN RIs1 OR AUTHORIZED REP ESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE S_ Gordon Craig the x mason,county assessor Dear We have recently received a copy of tax certificate for mobile home movement on your mobile home. In order chat we may accurately value you mobile home complete lete P P the questions below and return this form to our office by It is imperative that this information be provided to prevent a possible double assessment. MOBILE HOME DATA LENCH WIDTH / ,n r ^_�� MODEL .AXE �A N 4�Uy MODEL / jf' " YEAR MOBILE HOME LOCATION INFORMATION SERIAL, A. My privately owned land. YES - NO B. If rented or leased land who from? MAME ADDRESS CITY & STATE C_ Real Property Parcel # (cax statement �) D. Mailing name and address for owner of mobile home NAME .E� J• JU 62 141i�/� ADDRESS P, Di CITY & STATE F {l� �12, ��• E. Location address of mobile home CITY F. Date mobile home was placed on present site C. Purchase Price' �G DATE: i Ili, �� SIGNATURE TYPE OR PRINT NAME TELEPHONE NUMBER I Courthouse Shelton,Washington 98584 Phone 427-9670