Loading...
HomeMy WebLinkAboutBLD28036 MFG Home - BLD Application - 5/7/1991 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON WASHINGTON 98584 DATE ISSUED�r �-ell 01,e_a� fiA,-pF7( cam,��:` P�I�lew J -7Lp --- PERMIT N0. O NAME MAIL ADDRESS CITY&STATE ZIP PHONE OWNER Rc loer-F D-A 1114 Ell(� S vW 'Se, Pd- S , 24u , 60 k �''�K4- DIRECTIONS ! 2 _ I -* u � D Wes- TO JOB SITE �-� Ui'va-.'ir.�, V S .>� IZ � t {� � 0 J L ✓�-u2 4.p�� e5 — 0 PARCEL 3,7121 54 00t LI I LEGAL NUMBER 37,1 'L-7 S4 0biZ'Z DESCR. lLJ �2 -.�ZZ NAME MAIL ADDRESS 'CITY&STATE A,Efy'J ICENSE NO. ZIP PHONE CONTRACTOR ��K�1 s g V'3{''E" 21 ZL ©tte"SQ _ USE OF BUILDING �Q5 �,ca- CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE WORK ✓ DESCRIBE , ^ / `- WORK BEDROOMS 3 DECKS CARPORT NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS TOTALSQ. GARAGE CONDITIONING. NO.OF STORIES J_ BASEMENT K!C ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT , ,� COMMENCED WITHIN 180 SAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR TOTAL SQ.FT. l_t,w FIREPLACE YMJ DETACHED ''� ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. PERMANENT SHORELINE wy SEASONAL Ly' 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 TI;tE•-PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWIltHlNO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPR0'�7d.FRC THE BUILDIN 9,�PARTMENT. XOWNER DATE . XB' A� - DATE Z FOR OFFICE USE ONLY DEPARTMENT YES ENo DEPARTMENT YES NoBUILDING VALUATION b$O HEALTH i PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT D.O.T. BUILDING PLAN CHECK SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION SHORELINE WOODSTOVE QM t T L SSLte'q 5u$J,6e"r '-r8 Ge>;A t?4_, e� O� PLUMBING E-t� O / Z1 MECHANICAL gLlL S.� ✓ !C 0 df STATE BUILDING FEE e k STATE SURCHARGE APALICATION ACCEPTED BY PLANS CHECK BY APPR E ISSUANCE PERMIT VALIDATION --}- 3- BY CASH CK MO TOTAL 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 R06er-f" TO OBIONS SIITE �:� �tiLralitGK _ a!14-( w, Old L�Yr--e — L-4T V , naltk —Vow L-#It pq, 4 C4,j -4—5--, c_ C/" (' 111LX-, PARCEL 1212 Z1� 4 00121 LEGALNUMBER ' � OU1-ZZ. DESCR. S lv4:s l-Zlz Indicate below: O Property lines and dimensions. !' O Easements and roads. O Septic, drainfield and reserve area, or sewer. O Septic tank and drainfield setback distances from foundations. s 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. In Circle O Saltwater, lakes, rivers, streams,wetlands, drainage. O Attach copy of septic system"as built' or septic permit approval. O Indicate topography profile of property and structure on reverse side. Lb17 ,06 I ,00l I ,OS -LU �� v- oOYN,Oti1 �I o ,001 • 03-41 �n � r '� � g i•e - J J T 1 �lar'' IA C3, RpzhV \�J 0 � N 6 1,p,r:r-• \_, `- Z A ri it ``��t�� rG�•�.a Y 7 oL Q 0 o W J � l� 0 5•N e� V W _ O = o- 9 LL J o r a r W �1 in O I v J .x I/We certify that tt '' btaining approval. U � SIGNATURE OF OWNER(S)OR AUTHORIZE EPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE i TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE t II S. Gordon Craig the rnason county assessor Dea r He have recently received a copy of tax certificate for mobile home movement on your mobile home. In order chat we may accurately value you mobile home, please complete the questions below and return this form to our office by Ic is imperative that this information be provided co prevent a possible double assessment. MOBILE HOME DATA LENC>i ri1 D fJ IDTH Z X I `- MA,rE � , l��; , .-f-h,-,,., MODEL MDDQ. . � MOBILE HOME LOCATION INFOVMTION SIMI" it1 —117�- A, y privately owned land. YES NO S- If rented or Leased Land who from? UAME ADDRESS CITY & STATE C. Real Property Parcel (cax statement #) 03ZI Z7 J 001Z1 D. Mailing name and address for owner of bile home MAKE 'a�P s + 7 -5 S;;i S P ADDRESS C— l Z l] ca,Vh t"w l a f + CITY & STATE I-�L+vim, .JF E. Location address of mobile hom* 'X41-%A. CITY F. Dace mobile home was placed on present site C. Purchase Price r 4-7 z�I O DATE: —2 1 I SICNATURE ( \ �i C)1' TYPE OR PRINT NAME 1K bert TELEPHONE NURSER Q,6" 9 5N— Tyr 476-7766 Courthouse Shelton,Washington 98584 Phone 427-9670