HomeMy WebLinkAboutBLD4571 Storage Shed - BLD Application - 4/7/1977 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584 `
DATE ISSUED 7 7,7
PERMIT NO. �S 71
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
el i c V"Y _ -Y'-
DIRECTIONS
TO JOB SITE C
LEGAL (❑ SEE ATTACHED SHEET)
DESCR.
NAME MAIL ADDRESt CITY&STATE LICENSE NO. PHONE
CONTRACTOR
USE OF
BUILDING
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Desc 'be work:
_ t
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
!Jv �Q ro
SPECIAL CONDITIONS:
APPLICATION ACCEPTED BY PLANS CHECK BY I IAA.ROVED FOR ISSUANCE Type of Occupancy Division
�� BY Const. Group J—
SK57
Size of Bldg. No. of Max.
(Total) Sq. Ft. Stories Occ. Load /C
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D.NUMBER
I certify that I am a currently registered contractor in RESIDENCE
the State of Washington and I am aware Of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
HEALTH DEPT. 3 ye
Firm PUBLIC WORKS
By
ROAD DEPT.
Lic. No. Date
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
which this permit is issued and that all work done will
be in conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owners T9 ce(-19-if2zA.Date. WORK IS COMMENCED.
P AN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION 1KCK. M.O. CASH
I BUILDING PERMIT PLOT PLAN
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. Box 186 SHELTON, WASHINGTON 98584
427-9670 DATE ISSUED
PERMIT NO.
NAME AIL ADDRESS ITY&STATE ZIP PHONE;
OWNER to e
DIRECTIONS
TO JOB SITE
PARCEL ( LEGAL
NUMBER I DESCR
Indicate below. O Property lines and dimensions.
O Easements and roads.
O Septic, drainfield and reserve area, or sewer.
O Septic tank and drainfield setback distances from foundations.
O Location of proposed construction on property.
O Building & septic system setback distances from all property lines & easements.
Indicate North O Well and water line.
In Circle O Saltwater, lakes, rivers, streams, wetlands, drainage.
O Attach copy of septic system "as built" or septic permit approval.
O Indicate topography profile of property and structure on reverse side.
FTI
I/Y:e cenity that the proposto%ed cons, wiU I I
conforn to he dimensions and uses shown above and that no clan es will ba made without first obtaining approval.
i
V QQ
` r ` 812 SIGNA:U>;E OF cwNER;S)0R AUTHORIZED REPRESENTA,IvE
TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE
' I IT I I
f
8�
,,. the
mason county
assessor
Darryl Cleveland
Dear
We have received a copy of' the tax certificate for movement of your
mobile home . In order that we may accurately value your mobile
home , please complete the questions below and return this form to
our office by
This information is imperative to prevent a possible double
assessment on your mobile home .
TraYel y, , C.
HOME DATA LENGTH �t WIDTH—etVCt
MODEL
MAKE lim `0 �f
_/✓ lQ '> F 7 MODEL-* a-7014 YEAR
MOBILE HOME LOCATION INFORMATION SERIAL # -10
A . My privately owned land yeses no
OR
B . If rented or leased land who from? NAME
ADDRESS CITY & STATE
C . Real Property Parcel # \ i ( from tax
statement of new location ) !5
D . Mailing name and address for owner of mobile home
NAME to Z-//_0/Z Y'o -
ADDRESS �7 j- tl P (`% lid_ CITY & STATE CPS/L
E . Location address of mobi le home 4071/ Y / ? Cit y �`Ss���
F . Date mobile home was placed on present site r>y� ,� �
G . Purchase Price @&
DATE SIGNATURE .
TYPE OR PRINT NAME �C
TELEPHONE NUMBER
7 -7 411 N. 5th P.O. Box J Shelton, Washington 98584 Phone 427-96� �� ,