HomeMy WebLinkAboutBLD30910 Mobile Home - BLD Application - 10/14/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
v DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED �U
PERMIT NO.
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWN .T -
DIRECTIONS
TO JOB SITE i, Wt Qvr7 TEl Fe K On " 300 .7'
1 ,
O /Z wi i . �-i0 Sr 5 110 E 0P9,0
PARCEL LEGAL
NUMBER �z 33/ Z 3 9 O0 90 DESCR. �pT #3 OF _S /O 74 SEC 3/ TwP Z 3 IJ le i wr
NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR S
USE OF
BUILDING ES 1lDjff/VCE
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE �-
WORK �`--�-
c
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE/
.��SqFt STORIES SHORELINE❑ CONDITIONING.
BASEMENT SgFt BEDROOMS PRIMARY RES.O THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS $ Ft BATHROOMS SEASONAL RES.O COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
g ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE 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.
X OWNER, DATE i X BY - DATE
go w
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION Y
YES NO YES NO
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT G
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDINGGROUPJ PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE -�
i
ApPLICATIpIN P"P Y PUNS CHECK BYlD
APPR UFSS77_'_/J�SH
MIT VALIDATION
BY D
CK MO TOTAL /
the
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 Jam;., WIDTH �Z
MODEL
MAKE MODEL. YEAR
MOBILE HOME LOCATION INFORMATION SERIAL #
A . My privately owned land yes no
OR _
B . If rented or leased land who from? NAME
ADDRESS / ' CITY & STATE 3E1 Fig-x6. WX
C . Real Property Parcel # A?33 � Id �Dcl9 ( from tax
statement of new location )
D . Mailing /name and address for owner of mobile home
NAME
LCJ c�, CarV�
ADDRESS PC);�L'Y,. i� c5 �— CITY & STATE &'6��7/�' 41,6t
A ,4-t-/O
E . Location address of mobile home 4/9R5o^1 Lft. ,Qo1, City E1F
F . Date mobile home was placed on present site
G . Purchase Price
DATE 1 DT=`/* SIGNATURE
TYPE OR PRINT NAME ��;Fa'�ci
TELEPHONE NUMBER ;2
411 N. 5th P.O. Box J Shelton, Washington 98584 Phone 427-9670
i
BUILDING PERMIT PLOT PLAN
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