HomeMy WebLinkAboutBLD26579 Mobile Home - BLD Permit / Conditions - 8/29/1990 3 a1, � - -031�1q
Shorelines: Plunbing:
Setback: Mechanical:
Special Interior:
Conditions: FINAL:
Mobile Home:
Smoke Detector:
Remarks:
Footing:
Setback:
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE MOBILE HOME
Permit No. 26579 No. Floors 1 Sq Ftg 1188
Owner FARST R -,ONJA M_ Tel Date g_2q_g0
Address F �1 O (11 d I Rri Sh-1 tau Zip
Contractor r4pridian MnhilP HnmP,,
Address Zip
Legal Description i .,
I ; prick d, v 4 lnt 1qq
Direction to project site mi nn right side of Rri
(Ol d Lyme Rd)
P um ing Mechanical Sewer Woo Stove
Fireplace Deck Garage Carport
Basement -Loft Other XX
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
OWNER NAME MAILA DRESS CITY&STATE ZIP PHONE
.
i i E l0 OWL41mc, lRd gvsgq
DIRECTONS
TO JOB SITE (g A f Iq f
PARCEL r� LEGAL
NUMBER 301 �a 53601 LESCR. kof I Di%i iAke. II L' rick-
NAME MAIL DDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR IOLAMO ( am SO, V ( �33
USE OF
BUILDING 0 fY11e.
CLASS OF � ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE /
WORK 1plaC inq0 home
o On Sk� V y
BEDROOMS DECKS YOR N CARPORT NOTICE
TOTAL SO.FT.
BATHROOMS O� DECK GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
TOTAL SO.FT. TOTAL SO.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. TOTAL SO.FT. CHECK ONE ABANDONED FORA PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT FIREPLACE 1ATTACHED
SEASONAL SHORELINE DETACHED
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EX PT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
REGISTRATION LAW RCW 8.27,AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREMENTS FOR W H 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 T REWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROV RIOJ�THE BU G EPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER `��-1 ' DATE a �9 X BY _ DATE
FOR OFFICE USE ONLY
DEPARTMENT YES NO
NO DEPARTMENT YES
PPROVENO BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT a
D.O.T. BUILDING a/< 09• .2 PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP ge 3 PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE , (7
STATE SURCHARGE
APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION 7
BY�� y�z9-9v CASH CK MO TOTAL
PLOT PLAN
0 o IC51 1 114 Rd PERMIT NO. �
w s
'TION,DI,; 4 LOT Qq BLK ADDITION N
4REA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS I _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.
1 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
, t
l�
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.
NAM 1 OF OWNERS) OF SITE ! STRUCTURE(S) (PRINT) A T U OF OWNER(S) OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED G
DISTRICT AS NOTED ,( �, -.2 �� / DATE
S. Gordon Craig
7.
the
mason: county
assessor
Dear
We have recently received a copy of tax certificate for mobile home
movement on your mobile home.
In order that 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 to prevent a
possible double assessment.
MOBILE HOME DATA LENCH q 4WIDTH a e
II l MODEL
MAC & fY a n MODEL YEAR I-1Q 1 q
O
MOBILE HOME LOCATION INFORMATION SERI x
A. My privately owned land. YES NO
B. If rented or leased land who from? NAME
ADDRESS CITY & STATE
C. Real Property Parcel # (tax statement #)_ 3a I r 7 53 9 9
D. Mailing name and
and address for owner of mobile home
NAME Ol 1 °,(�s 1 y b 1 (,0 fl 1 cL W P,3orsl e r
ADDRESS E ( Q Icl (W me_ ^-A CITY 6 STATE Slle i on
E. Location address of mobile home S OLi11 p� CITY
F. Date mobile home was placed on present site
C. Purchase Price
DATE: C) SIGNATURE
TYPE OR PRINT NAME Sonl'(kfS�e�
TELEPHONE NUMBER
Courthouse Shelton,Washington 98584 Phone 427-9670