HomeMy WebLinkAboutBLD29491 Storage Only - BLD Application - 11/7/1991 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W.CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427-9670 DATE ISSUED Z-51
PERMIT NO.
OWNER ME MAILADDRESS CITY&STATE ZIP PHONE
DIRECTIONS r i -4-I 0
_ q y
TO JOB SITE ycf�
-2cm l-I�c W�� n-Fo l �-f .+
(J+. fbL C 1-)e d (-'�r) S.Q pt I c- C P� n k c opu
PA CEL LEGAL K11IC-N I. t;?o)l.Z oT INZ
NUMBER 041.- DESCR.
CONTRACTOR NAME MAIL ADDRESS CITY&STATE ZIP PHONE LICENN NO.
USE OF ff V U`cS{-�-C,/
BUILDING SI(Y C I
CLASS OF NEW j/ ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE WORK C� �,r./1
fc)Q
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
RESIDENCE ta&SgFt STORIES t _ SHORELINE❑ CONDITIONING.
BASEMENT �� SgFt BEDROOMS PRIMARY RES. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS $ Ft BATHROOMS COMMENCED WITHIN 180 JAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
q SEASONAL RES.O ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT-ZAtgFt FIREPLACE IS CARPORT/GARAGE
GARAGE --e"- SgFt ATTACHED 13(DETACHED 0
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
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 f 0-/S-`1 1
FOR OFFICE USE ONLY
APPROVED APPROVED
DEPARTMENT YES No DEPARTMENT YES No BUILDING VALUATION v
HEALTH PUBLIC WORKS ��i44EE.,;V-j
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
's FOE " ' IE A&REONLIV PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY PLANS CHECK SY APP: DFO �U ANCE PERMIT VALIDATION O ti;
TOTAL
-q BY ( ASH CK MO ���
BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
426 W. CEDAR/P.O. BOX 186 SHELTON,WASHINGTON 98584
427.9670 DATE ISSUED
PERMIT NO.
ME _ MAIL ADDRESS CITY d STATE ZIP PHONE
OWNER / L
/8141{
DIRECTIONS
TO JOB SITE l�'L r`r� 1`IGt�::�.�� �\IG'c_l, ✓�, IL' =��P�'� ( �.� .�rl ��
tcl _
PARCEL LEGAL E FA /.! i C� � U� r'� I fl 7_� 1 %li(`� C�r
NUMBER
DESCR.
NAME _MAIL ADDRESS CITY d STATE ZIP PHONE LICENSE NO.
CONTRACTOR ` �'j-E�(<' .• I hC-,4 i� ��; F" I�(`I�I' 1. •'� f' � 31
USE OF {{ {
BUILDING
CLASS OF NEW Ir/ ADDITION ALTERATION REPAIR MOVE REMOVE
WORK r
DESCRIBE 1 ( l
WORK rz
off-$
AREA: NUMBER OF: PLEASE INDICATE: NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING. HEATING. VENTILATING OR AIR
RESIDENCE I�SgFt STORIES_�_ SHORELINE O CONDITIONING
BASEMENT —fi" SgFt BEDROOMS Z PRIMARY RES.I' THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
DECKS oZ vC Ft BATHROOMS COMMENCED WITHIN 180 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
Sq SEASONAL RES.O ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
CARPORT SgFt FIREPLACE IS CARPORT/GARAGE
GARAGE SgFt ATTACHED 3 DETACHED O
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT 1 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
08TAININGAPPROVAL FROM THE BUILDING DEPARTMENT APPROVAL FROM THE BUILDING DEPARTMENT.
C r C
XOWNER DATE X i A" DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVE NO DEPARTMENT YES No
BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE MARSHAL BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP m PRE-INSPECTION
SHORELINE
_ WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
APPLICATION ACCEPTED BY I PLANS CHECK BY A O-,-,,ED F ISSU E PERMIT VALIDATION
TOTAL
BY SH CK MO
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 .
MOBILE HOME DATA LENGTH WIDTH
MODEL .�
MAKE M0DEL V� YEAR
MOBILE HOME LOCATION INFORMATION SERIAL #
A . My privately owned land yes ' no
OR
B . If rented or leased land who from? NAME
ADDRESS CITY & STATE
C . Real Property Parcel # ( from tax
statement of new location )
D . Ma/i�ling name and address for owner of mobile home
NAME
ADDRESS CITY & STATE
j4A\J'Cn U-k-" /*4CiC9- Cht(
E . Location address of mobile home z9,�1' City
F . Date mobile home was placed on present site
G . Purchase Price
DATE SIGNATURE
TYPE OR PRINT NAME �� �at,-)n �IY�LS
TELEPHONE NUMBER �C4 �j
411 N. 5th P.O. Box J Shelton, Washington 98584 Phone 427-9670
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