HomeMy WebLinkAboutBLD26713 Move Mobile Home - BLD Application - 9/14/1990 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED 19
PERMIT NO.
OWNER NAME MAILADDRESS CITY SSTATE ZIP PHONE
WA Av
DIRECTIONS
TO JOB SITE
Tv L UT 3
PARCEL LEGAL e�
NUMBER DESCR. i kO
y.3 �v o , i � c� 06
NAME MAILADDRESS CITY SSTATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE „ n �9-7� v /
WORK �(/�-�./ �l
BEDROOMS _ DECKS YO CARPORT TOTAL NOTICE
TOTAL SQ.FT.
DECK GARAE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL TOTAL SQ.FT. OTAGSO.FT. 0_ CONDITIONING.
NO.OF STORIES BASEMENT YOFQ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
LIVING AREA BASEMENT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. TOTAL SO.FT. CHECK ONE ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
PERMANENT 1,0!!�— FIREPLACE .Za_ ATTACHED
SEASONAL SHORELINE /V �) 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
REQUIFfMENTS 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 CO FORM THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING
OBTA IN PPROV FRO HE BUILD G DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
VYNE Wt DATE X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YES
PPROVEDJO DEPARTMENT YES DEPARTMENT BUILDING VALUATION
HEALTH I PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING L PLAN CHECK
SPECIAL CONDITIONS BUILDINGGROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE ,
STATE SURCHARGE
APPLICATION ACCEPTED BY P NS CHECK BY A D F O SSUANCE PERMIT VALIDATION
TOTAL
l4�V BY CASH CK MO /
PLOT PLAN
ADDRESS PERMIT NO. � 7 C c
i •
s c i
LEGAL
DESCRIPTION �j LOT BLK ADDITION
SITE AREA O Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS 600 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. SHI',W LOCATION OF WATER, SEWER, GAS AND ELECTRICAL
SERVICE LINES.SHOW LOCATION OF SURVEY FINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF,
0 INDICATE NORTH IN CIRCLE f v GRAPH SQUARES ARE 5' X 5' OR 1"=20'
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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.
� � J
NA a) OF OWNER(a) OF aITE a RUCTURE(a) (PRINT) IGN URE OWNER(al O -A TNO D P EIENTATI -----
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
fill /
S. Gordon Craig
the
mason county
assessor
Dear
We have recently received a copy of tax certificate for mobile home
movement on your mobile home.
In order that we may accurately value you mobile home, please complete
the questions below and return this form to our office by
It is imperative that this information be provided to prevent a
possible double assessment.
l
MOBILE HOME DATA LENCH WIDTH
MODEL _
MAKE L 835 b%T.— MODEL I Ll YEAR // 7
MOBILE HOME LOCATION INFORMATION SERIAL # q QQ 3S I b I O�
A. My privately owned land. YES__Ief-- � NO
B. If rented or leased land who from? NAME
ADDRESS CITY & STATE
C. Real Property Parcel /# (tax statement /#9
D. Mailing name and address for owner of mobile home
NAME fl
ADDRESS�Y CITY A STATE �iU�l✓'l'1
E. Location address of mobile home CITY
F. Date mobile home was placed on present site
C. Purchase Price d0
DATE: SICNAT E
TYPE OR PRINT NAME
/�� S.
TELEPHONE NUMBEI}I z��
Courthouse Shelton,Washington 98584 Phone 427-9670