HomeMy WebLinkAboutBLD N/A Cancelled Mobile Home - BLD Application - 12/9/1992 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS CITY 8 STATE ZIP PHONE
OWNER i SQ Pd. Anx 16-73,2
DIRECTIONS 1
�/ `�
TO JOB SITE C� 7- fie0h� �{L641'e 0*1 11wfy ,300 Ugpl ICI y"
PARCEL LEGAL / AA
NUMBER 333 33 ODgD DESCR. r � / Z �--`0� 3 ,�sl�'
NAME MAIL ADDRESS CITY 8 STATE LICENSE NO. zip, PHONE
CONTRACTOR
USE OF
BUILDING r de
CLASS OF NEW ��7 ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r1) N
DESCRIBE
WORK S'c 'fie. rn C
BEDROOMS__.�'� DECKS - CARPORT NO IC 11��
SEPA T PERMITS RE R WIR D P RING, H TIN V NTILATING OR AIR
BATHROOMS� TOTAL SQ.FT. GARAG ___ coND1Tl
NO.OF STORIES � BASEMENT AT H D IS PERMIT C ESTF1
D IF W K OR RUCTION AUTHORIZED IS NOT
COMMENCED WIT IN 1IF CO TR 10 OR WORK IS SUSPENDED OR
TOTAL SQ.FT. ��,� FIREPLACE _ E A H ABANDON D FOR A S AT AN M FTER WORK IS COMMENCED.
PERMANENT _�_ SHORELINE (1
SEASONAL ��J)
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVI
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, ROV FROM THE BUILDI EP RTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNE DATE ✓ Ll ` X BY— DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVENo DEPARTMENT YESPPROVENO BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS ,/BUILDING GROUP ` PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE J
STATE SURCHARGE �f
APPLICATION ACCEPTED BY PLANS CHECK Y APPaVER7ISSPCE PERMIT VALIDATION TOTAL
B� CASH CK MO
BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER 3
DIRECTIONS p
TO JOB SITE Si' Rok" Eelrl 1/!f? o �"'jW 306 7-ak /l I 4`)r
PARCEL LEGAL
NUMBER 1,,V331 3 O09D DESCR. 74k2 Z
r
Indicate below: O Property lines and dimensions. .3 Cyr -SOO
O Easements and roads.
O Septic, drainfield and reserve area, or sewer.
O Septic tank and drainfield setback distances from foundations.
O Location of proposed construction on property.
O Building& septic system setback distances from all property lines& easements.
Indicate North O Well and water line.
O Saltwater, lakes, rivers, streams,wetlands, drainage.
In Circle O Attach copy of septic system"as built' or septic permit approval.
O Indicate topography profile of property and structure on reverse side.
1.0
i \
N
r r
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.
SIGNATURE OF OWNER(S)OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
S. Garden Craig
5., .�
the
Masan
assessor
IIaa r
We have recenzly received a copy of caz certificate for mobile home
movement on your mobile hamo.
Za ocder chat we may accurately value you mobile hen=, please coe,plece
the questions below and return this for= to our office by
Iz " imperative that this information be provided cc prevent, a
passible double assessment.
tsars LI.E rim aATA
k=rL.
MArr- 2 P rv��� l�DELc MAR
HCZS=.S HCHE L.CCA,=CN INFC2MAIICH SEETAL
A_ My pc-LvaceLy owu d Land_ M= No-
3- I.f cenced or Leased Land who from? MARE
ADDRESS ^�b . G \ V CIZl' & ==
C_ ReaL ?roperty Parcel # (cam scacemanc #) jZ 331 Z -3 "lC:CX�1
D_ HaiLiag name and address for owner of mobile home -
KAl� 0 vc,
C= a
E_ Loeaeion address of mobilc homm CITY
F'_ 0ace mobilc hame was pl-aced on presenc site
C. Purchase ?r icc �i1�Y1G r\
DA2S: Cj / G, ' C S ICNA=E
I7PE 08 P4L'iT NA2lr VI
TELzP4C1iE NE20EZ
Courrncuse Shefron, Wasnington g8y3.t pRone 427-1670