HomeMy WebLinkAboutBLD23774 Mobile Home - BLD Permit / Conditions - 5/25/1989 -q
3@13 �1 a s
:
Shorelines: Plunbinglyechanica
Setback: Interior:
Special FINAL:
Conditions: Mobile ome:
Smoke Detector:
Remarks: 'r�R�z'c
oot ing.
it V�11 �LJ/�tL2� s1
Setback: rh.4,PDRL� Li �� R1o4,
Foundation
Walls:
Framing:
Fireplace:
Wood Stove:
TYPE MOBILE HOME
23774 No. Floors Sq Ftg 1620
Permit No. Tel 427-9318 Date 2
Owner WARD, Jerr J Zip
Address ensen Rd Shelton
Contractor Charlies Zip
Address
Legal Descripton site TrPast 032-21 -
Direction toproject 11
turn right, to down straic i ht stret h
until ou see land with fence & sm 11 o tove
IIItm l Deck ica Garage wer Carport
Fireplace Basement Loft Other
3 bdrm
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
C'�r� c��5U D
7i 427 9670 ATE I U D
I! PERMIT NO.
N E I MAIL DRESS NITY&STAY ZIP PHONE
OWNER % Y �1 �ard �C31
DIRECTIONS
TO JOB SITE 'pkA mQ tL \ k U ,
PARCEL(J LEG L \ ? 4 PR' y-
NUMBER DESCR. I I LU 9 n, aa
CONTRACTOR
NAME MAIL ADDRESS CITY S STATE LICENSE NO. ZIP PHONE
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE (�
WORK Ck bl
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS�_ TOTAL SO.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. ito U FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE J
SEASONAL /CjtS/
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY TH T I AM EXEMPT FROM THE REQUIREMENTS OF THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY REGISTERED CONTRACTOR IN THE STATE OF
CERTIFY
LAW RCW 18.27, AND AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDINANCE REQUIREMENTS REGULATING THE
REQUIREME S 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 CONFO ANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAININ PPROVAL FROM THE BUILDING DEPARTMENT. /�]_ Q APPROVAL FROM THE BUILDING DEPARTMENT.
X OW R L- �'`DATE ��- /�L9 X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVE NO DEPARTMENT YESPPROVENQ BUILDING VALUATION Q
HEALTH PUBLIC WORKS T FEE
PLANNING FIRE BUILDING PERMI U t 0
D.O.T. BUILDING �� PLAN CHECK tA
SPECIAL CONDITIONS // BUILDINGGROUP PRE-INSPECTIO
/de a. f LDS- /frCfn /c SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE c7
STATESURCHARGE
A LI N ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
BY y�(� J/ CASH CK MO TOTAL �a
', 1
PLOT PLAN
ADDRESS r/ / _ i/Ti' (j�f Z /.�'P1=RMIT N0. 0
f o
o
0
LEGAL
DESCRIPTION � — LOT BLK ADDITION u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 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 A"'D 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.
0 INDICATE NORTH IN CIRCLE K_ GRAPH SQUARES ARE 5' X 5' OR 1"=20'
C r
I/We certify that the proposed constructions ilI rm4?1bt dirrya i&s and uses shown above and hat no changes will be made without
first obtaining approval. �1
NAME( ) OWNEIR(3)01FOITE a STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHEL-TON PR;NTINS
T !, E 14 A S r n �
_ SSA
P,nJrLAS
PLEASE S'i°PLY T�40L" aOLLf" 'r, I"r0r"'11TIn-
nEr APE)F'r. vni l^ ,,Or I Lr. ;nr
Owners "ame: Ara Tel e # a rf 45/
Mailin0 Pddress
Previous :lobile Home Owners Mame & Address
Description of Mobile Hone: ( Infomation is on your registration certificate)
Out
Ma ke 6kI.A IJ i fin Size
Year-20 ISerial # �3aq L(2 �) Lp aV dE2
Year Purchased]M_Price (Less furniture & sales tax) •d
If locating in Mobile Home Park:
Naale of Park: Soace
If NOT in F".obile Home Park:
Do you own the land on which the home is placed? Yes A "lo
Real Property description A ) � '4'(1 )�
Owner of Land if you are NOT the Owner:
r3rief direction to location: Qa ( ri kf
V
_ate Fiobi a Home .Entered F"ason Countv: 10A iW
Date you anticipate moving rlohile Hor.e to another location: �u
If moved from a Mobile Hone Park civil:
Name of Park: Soace #
Your hone will be placed on the rolls of F'ason County. !-'e would appreciate a
prompt reply. Please feel free to contact this office if you have any questions
at all
Very truly yours,
Helen Maser
Personal Property Department
wne s Siona ure T____u�te-__�_