HomeMy WebLinkAboutBLD10443 Mobile Home - BLD Application - 4/23/1981 * ' 'BUILDING-PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED �
PERMIT NO.
OWNER NAM/l1AIAE MAIL ADDRES 11 C sw2,o2 so oZg,O Ci CI 6b-FA/� !7 • 9G75�•� a7S_PHONETY&STATE ZIP
DIRECTIONS
TO JOB SITE y /n/L.E.S UP NOR721SHOR E NWY 7URAI R i G hl T O� /Hiss/aa C�k,
LEGAL C C l _ (O SEE ATTACHED SHEET)
DESCR. J �Z J t /ICI Jt !/Z �(�/eAG�`S I —.2J p 3 ..
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR t F
USE OF
BUILDING
Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR OVE ❑ REMOVE
Describe work:
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EL t C 7-2 G/ T t //►lS >A L L id R TE2 Ti9/J lZ C L E,9/L 2 O&D&),09
/V x 7
Valuation of work: $ PLAN CHECK FEE. PERMIT4tE„
SPECIAL CONDITIONS:
BEDROOMS I DECKS CARPORT ❑ NOTICE
BATHROOMS I TOTAL SQ. FT. CaARAGE ❑ NON,
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIE BASEMENT L1 OR AIR CONDITIONING.
TOTAL SQ. /O O FT. FIREPLACE ❑ DETACHED ❑
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR-
CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION QR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
I certify that I am a currently registered contractor in WORK IS COMMENCED.
the State of Washington and I the
aware of the FO OFFICE USE ONLY
ordinance requirements regulating the work for which
the permit is issued and all work done will be in
conformance therewith. PERMANENT SHORELINES i
SEASONAL ❑ FLOODPLAIN Li
Firm E.D. NO. S.E.P.A. ❑
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
DEP .
f C
OWNERS AFFIDAVIT HEALTH DEPT.
I certify that I am exempt from the requirements of the FIRE MARSHAL
contract or registration law RCW 18.27, and am aware BUILDING DEPT.
of the Mason County ordinance requirements for
which this permit is issued and that all work done will ROAD ACCESS
be in conformance therewith. MOTOR VEHICLE PERMIT
AP TION AC EPTED BY PLANS CHECK BY ABYPROVE FOR ISSUANCE
Owner Date . O` d /7 I
�` / /
P AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CAS14
PLOT PLAN
ADDRESS ,\ �/�)C PERMIT NO. 0 `
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LEGAL _ a
LOT _ BILK ADDITION
DESCRIPTION 2,5 ` u
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS—If
X" 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"ID 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,
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= y a
INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"--,0
75 /
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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 OWNERS) OF SITE 6 STRUCTURE(S) (PRINT) SIGNATURE OF OWNERS) OR AUTHORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS LINE
APPROVED
DISTRICT AS NOTED DATE
SHELTON PRINTIN3
mason county federal credit union
P.O.BOX 176/521 RAILROAD AVENUE/SHELTON,WASHINGTON 98584/(206)426-1601
P.O.BOX 206/BELFAIR CENTER/BELFAIR,WASHINGTON 98528/(206)275-6066
RON SANFORD,GENERAL MANAGER
April 22, 1981
TO WHOM IT MAY CONCERN:
ON NOVEMBER 16, 1979 THE FOLLOWING DESCRIBED UNIT WAS SOLD TO ANNA KEITH, BY
MASON COUNTY FEDERAL CREDIT UNION AS A REPOSSESSED MOBILE HOME, FOR THE SUM
OF $5,490.11.
1973 SEQUOIA 14'X 70' MOBILE HOME, SN 244022S1971, IN 87619 TPO
TITLE NUMBER 7901903815.
TOM NORTHUP
ACCOUNTS CONTROL DEPARTMENT
EXT #233
CREDIT UNION SERVICES AVAILABLE TO ALL RESIDENTS OF MASON COUNTY
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