HomeMy WebLinkAboutBLD0482 Mobile Home - BLD Permit / Conditions - 1/13/1987 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED // 3
PERMIT NO.
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE
LEGAL
DESCR.
NAME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING 0 17 Ted
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK (� m--
47
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SO.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SO.FT. �'c FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
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
REGISTR ION LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIR ENTS 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 CO ORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
BTAI ING APPROVAL FROM THE No CHANGES
�` APPROVAL FROM THE BUILDING DEPARTMENT.
WNER LI�Ar � �Cl.1�fi�;DATE I L` X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES APPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION _
_�f�lJ• �n
HEALTH PUBLIC WORKS FEE
PLANNING �I' FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP — PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHEC BY APPROVED FOR ISSUANCE PERMIT VALIDATION
tc-vG� BY CASH CK MO TOTAL' J
y,
PLOT PLAN
ADDRESS PERMIT NO. o
f o
i o
n >
LEGAL a
DESCRIPTION LOT BLK ADDITION u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS— �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 DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION AND SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF.
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
C.
FT
J
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.
NAME(S) OF OWNER(S) OF SITE & STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(SI OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
i
rn^gin° r^qIr
ANCESSOR
THE Re A S O '. C C ,1 ,, T Y ^ S S E SSOR
pf):lr,LAS JO?vES
C"IEF rPn!ITY
PLEASE S"IPPLY THE" )LU"r,"I f'�
REr-ARD I,'r: V0 in "Or I Lf" 1-'',O'T :
Owners Name: Tele #
2 A N K?, I� C,�
► �7
ilia 11inq Addres ,y,
�E t-FP I [ �WP
Previous Mobile Home Owners Name Address jqo mjj� iM(-4(;,,r, Sp,r=
Description of Mobile Home: (Information is on your reristrat4on certificate)
Make N E:t,_) Mood - Size
Year I Q 6,5 Serial #
Year Purchased(`1812, rice (Less furniture a sales tax) $ 2—,0c)0
If locating in Mobile Home Park:
NaMe of Park: A 1 4 Space # 4)�
If NOT in �lobile Hone Park:
Do you own the land on which the home is placed? Yes "!o
Real Property description L-T, / 4- T'0 1 U E�
- -
Owner of Land if you are EIOT the Owner: Ng
Brief direction to location:
Date f1obi l e home Entered "ason Countv: (C) �q--
Date you anticipate moving Mobile Hori.e to another location: Lj6 -ECoc2
If moved from a Mobile Hone Park rive:
Warne of Park: 0 7-�- Space #
Your hone will be placed on the rolls of f•lason County. !,!e a!ould appreciate a
prompt reply. Please feel free to contact this office if you have any questions
at all .
Very truly yours,
Helen C-laser
Personal Property Department
'
wners Si nnature --- Date--------