HomeMy WebLinkAboutBLD92-00916 Cancelled Mobile Home - BLD Permit / Conditions - 6/7/1993 MASON COUNTY
Mason County Bldg. 111 426 W. Cedar
P.O, Box 186 Shelton, Washington 98584
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CONCRETEJ\X% ' �� MECHANICAL MOBILE HOME
Footings date by Ribbons
date o r Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by . l-A
FRAMING Walls FIRE DE PT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
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MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED 40
PERMIT NO. 3L-PL ��
NAME MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER Lloyd
loy & :�rie Anderson 200 Tacoma St . Grants Pass Gr.97526 0 - 6-618
DIRECTIONSuu to Lake = urn rig o Lake Limericic—Lio straight
TO JOB SITE ahead at Stop Sign--Olde Lyrae Rd . is at bottom of Hill.
PARCELLEGAL
NUMBER 2127-54-00097 1 ESCR. Lake Limerick --Div. 5 Lot 97
NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENSE NO.
CONTRACTOR
USE OF
BUILDING �`:anufactured Home--kerm . residence
WORK r CLASS OF NEW X ADDITION ALTERATION REPAIR MOVE REMOVE
DESCRIBE
WORK Construct Foundation for i�if . Home
AREA: ' NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE �qFt STORIES SHORELINE U CONDITIONING.
BASEMENT SgFt BEDROOMS 2 PRIMARY RES.�X THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
DECKS Lat ersgFt BATHROOMS 2 SEASONAL RES.❑ ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT 11 SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED U 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 WHIC HE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST C ORMANCE T REWI NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPR FROM TH ILDI DEPARTMENT.
XOWNER '3.t' DATE _�A 97/ XBY �— DATE f/ O Zi
FOR OFFICE USE ONLY
AD DEPARTMENT YESPPROVENo DEPARTMENT YES NO
BUILDING VALUATION
HEALTH M PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT i
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP L�7 , PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE L
ATL19#10N ACCEPTE BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION qL12141
TOTAL
[L'�C� BY CASH CK MO
the
{ mason county -2 _ n 1 G
assessor V k
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 . 2y x (00
MOBILE HOME DATA LENGTHS WIDTH
bV A Tjrc r=o RJA (/7A�V L//�1f) 2 V 2 44'7 MODEL
MAKE- MODEL YEAR 1992
T e—i e Btti 1-t
MOBILE HOME LOCATION INFORMATION SERIAL #
A. My privately owned land yes x no
OR
B . If rented or leased land who from? NAME
ADDRESS CITY & STATE
C . Real Property Parcel # 32127-54—OOC97 ( from tax
statement of new location )
D . Mailing name and address for owner of mobile home
Lloyd 6c Marie Anderson
NAME
ADDRESS 200 Tacoma St . CITY & STATE Grants Pass, Or.
97526
E . Location address of mobile home E 681 Glde Lyme Rd . City Shelton
F . Date mobile home was placed on present site To Be Built
G . Purchase Price 4�;908-
DATE 6-12-92
SIGNATURE ���cs �►�
TYPE OR PRINT NAME +J 'V � '`Rsa.✓
Irj� TELEPHONE NUMBER `&?3 -