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Home My WebLink AboutBLD0064 Mobile Home - BLD Application - 12/21/1988 BUILDING PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. NAME MAILADDRESS CITY&STATE ZIP PHONE OWNER �L� G 3 _ 74 , DIRECTIONS TT TO JOB SITE 0 AlEC - .LJE lyAT�'D �1LATf,�2D 47O de-LFAi/Z PARCEL LEGAL NUMBER DESCR. 77 NAME MAILADDRESS 'CITY&STATE LICENSE NO. ZIP PHONE CONTRACTOR �gEL USE OF BUILDINGCLASS WORK O✓ NEW ✓ ADDITION ALTERATION REPAIR MOVE REMOVE DESCRIBE JOK-IoOfrr WORK Q VFe Q & ES G V sxex BEDROOMS__ DECKS CARPORT N NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING. NO.OF STORIES BASEMENT ATTACHED lI 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..:6_QQ FIREPLACE DETACHED S/ ABANDONED FOR A PERIOD OF180 DAYS AT ANY TIME AFTER WORK ISCOMMENCED. PERMAN NT SHORELINE SEASONAL Byi 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 THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN JINONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING NING APPROVAL FROM THE BUIL INGDEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. NE / ATE �� f X BY DATE FOR OFFICE USE ONLY DEPARTMENT APPROVED DEPARTMENT APPROVED BUILDING VALUATION YES NO YES NO 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 STATE SURCHARGE APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION CASH CK MO TOTAL �JJ PLOT PLAN 12S,9 k-7, 4 c-L,6�A A/ O L,C- o M E' U wrVri ,e ADDRESS /V � �5 ��L(/i9��Q ��= PERMIT NO, s / p � > LEGAL 7 G�/ ' SO ICJ L�C �R A LTeS S�G �GUf oIv /� 2 �(! ✓ ', DESCRIPTION -7 G/ LOT BLK /�/DD,(I�TION SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDWGLS� a[(U4ZS. 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. • INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' ( \J Arai 0.1 EAA N � o �e �m o � c � I/We certify that the proposed construction will conform to the dlmensialne and uses shown above and that no changes will be made without 0 first obtaining approval. �p K NA EI O WNER(al O T a STRUCTURE(S) (PRINT) 1IGNATURE OF OWNER(S) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE QSNCSSOR THE ": ASO ': C01,31141TY ", SSE SSOR nJnLAS JOKES HIEF *`FPUTY PLEASE S')PPLY THE rOLL01.11VG I111:0ri"'1TI0w RU7-ARD I v!s V01-17, "07 I LF P0.1"E: ti c 1 1 - -017 Owners .dame. �,,4� Te e � � 7�2 :PJ Mailing Address >C -1 Previous M- obile Home Owners Oame & Address �1r9sT�,y -S', �o &1, e- Description of Mobile Home: (Inforration is on your registration certificate) viake 2-"� 7— - Size s X D Year L 7 Serial # S 7 Year Purchased�1e Price (Less furniture & sales tax) $ Q/�. Gu If locating in Mobile Home Park: Name of Park: Space # A T ' If i;OT in Mobile Home Park: Do you own the land on which the home is placed? Yes NO X Real Property descrintion % yc-7 '#1 L- k/c./ts'o Owner of Land if you are NOT the Owner:KCAL- J- AJ Brief direction to location: 4Ae, vTs A%— ly,6� 9' Oo F,4 f- C l2FE.lk. K i) A 1: Date Mobile Home Entered Vason County: Date you anticipate moving Mobile Home to another location: If moved from a Mobile Home Park dive: Marie of Park: A Space # Your home will be placed oh/the rolls of Mason County. bVe would appreciate a prompt reply. Please feel free to contact this office if you have any questions at all. Very truly yours, Helen Claser Personal Property Departmentt r � wner Signature -----Date--