HomeMy WebLinkAboutBLD0657 Mobile Home - BLD Application - 5/3/1988 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
3
427-9670 DATE ISSUED O�
PERMIT NO. �" S
OWNER NAM MAILADDRESS 05k T�jE��� �.- � ZIP PHONE
rz P Q�►�. �lv J o { N���l (1 C�
DIRECTIONS J!'�-n /V/ D— fa/Cc U��u� �, , ' (.�,� e- pd/ Lm 1 l 104
TO JOB SITE _a m G �v WL Pfi6 n -5 x- Yt 13;� ��e . '0 i4 NA 'n La.P T �
h IC0-IV-le-' o iY� R 0) / Lt,nv-► ►V
e + r � /1
PARCEL � I T O � LEGAL ` 'j� Vr f Su o v AGE A L / T: ,
NUMBER v LEGAL. �l U
NAME MAIL ADDRESS CITY&STATE ���� LIC NSENO.r�f, 7�p � ��`
CONTRACTOR C /)
USE OF
BUILDING - .14 0vi e
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE --[REMOVE
WORK
DESCRIBE
WORK
1716C
BEDROOMS DECKS CARPORT NOTICE
BATHROOMS TOTAL SO.FT. GARAGE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
CONDITIONING.
NO.OF STORI ES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
TOTAL SQ.FT,/
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
� FIREPLACE DETACHED ABANDONED FOR A PERIODOF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED,
PERMANENT SHORELINE
SEAS9, AL
%/NERS 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
IN CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X OWNER DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT APPROVED DEPARTMENT APPROVED
YES NO YES NO BUILDING VALUATION Gi
L
HEALTH PUBLIC WORKS FEE
PLANNING Vjit, FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP -3 PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE G'
STATE SURCHARGE ,
APPLICAT NAC TEDBY PLANS CHECK BY APPROVEIR FOR ISSUANCE PERMIT VALIDATION
4 , �- y ► TOTAL
BY CASH CK
1
PLOT PLAN
.'}A�(DDR�E�S]S� PERMIT NO. i o
A >
O
O
LEGAL DESCRIPTION LOT�' A S 5 4 B 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 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 SQUAR S ' X 5' OR 1"=20'
r V r A
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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.
NAME(S) OF OWNER(S) OF SITE S STRUCTURE(S) (PRINT) SIGNATURE OF OWNER(S) OR AUTHORIZED REP ESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
,I
Q� E S0R
T !? E ^" A S 0 ': C 0U Y S C r S S 0 n
Rn ir1AS JONTS
tPIEF rr'-'UTY
PLEASE SUPPLY THE na'
REO.APn I':r VN In 1,70r I LF EWT :
Owners Name: Lf Tel e # g 3
Mail inn Address 6 ti 1.e-
OZ .
Previous Mobile Horne Owners 11ame & Address
Description of Mobile Horne: (Inforr!ation is on your renistratnon certificate)
Puke Size o X '66
Year Serial #
Year Purchased NO Price (Less furniture & sales tax) $
If locating, in Mobile Nome Park:
NarAe of Park: Space #
If ",'OT in lHobile Hone Park:
Do you own the land on which the 4ome is placed? Yes_ Y, P!o ,
Real Property description
Owner of Land if you are NOT the Owner:
Brief direction to location: Oaa �RRS`� 54//3
Date P2obile Home Entered !"ason County:
Date you anticipate movinn Mobile Home to another location:
If moved from a Mobile Home Park Rive:
�!arie of Park: mace #
Your hone will be placed on the rolls of Paason County. !�'e wnuld appreciate a
prompt reply. Please feel free to contact this office if you have any questions
at all .
Very truly yours,
Helen Cl aser
Personal Property Department::
J�
Owners Sionature ---Date--