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HomeMy WebLinkAboutBLD N/A Mobile Home - BLD Application - 8/18/1983 BUILDING PERMIT APPLICATION MASON COUNTY P.O. Box 186 Shelton, Washington 98584 3� 426-5593 L6 T DATE ISSUED _ PERMIT NO. NAME MAI ADDRE S CITY 8 STATE ZIP PHONE OWNER 0 0 2i 4 j 42� 7 38" DIRECTIONS TO JOB SITE Q C. /y�S L Y LEGAL /� / / /� (❑ SEE ATTACHED SHEET) DESCR. S 3 �Gi c01� L. Ke U �v h !�/� o F �ff 9 6 Af6,5e Cciv �y CONTRACTOR NAME MAIL ADDRESS CITY 6 STATE LICENS NO. PHONE / USE OF BUILDING e C e Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE Describe work: Q `Yj Valuation of work: $ 9 coo PLAN CHECK FEE PERMIT FEE,,i� c� 4 SPECIAL CONDITIONS: BEDROOMS__ DECKS CARPORT ❑ NOTICE BATHROOMS TOTAL SO. FT. GARAGE L' ATTACHED f_] SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING NO. OF STORIES BASEMENT ❑ OR AIR CONDITIONING. TOTAL SO. 1`7_4EVO FIREPLACE ❑ DETACHED L THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHOR- CONTRACTOR AFFIDAVIT IZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR 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 FOR 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 ❑ Firm E.D. NO. S.E.P.A. ❑ By Special Approvals IN OUT YES APPROVED NO Lic. No. Date ZONING PLANNING DEPT. OWNERS AFFIDAVIT HEALTH DEPT. PUBLIC WORKS I certify that I am exempt from the requirements of the FIRE MARSHAL contract or registration law RCW 18.27, and am aware of the Mason County ordinance requirements for BUILDING DEPT. which this permit is issued and that all work done will ROAD ACCESS be in conformance therew' MOTOR VEHICLE PERMIT APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE Ow Date. BY PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH THE MASON COUNTY ASSESSOR PLEASE COMPLETE THE FOLL014ING INFORMATION REGARDING YOUR MOBILE HOME: Owners Name: G e o 1—a F' ti l 0 0//' Pa T e 1 e # 7, -3 3 Availing Address r 4 —) Previous Owner & Dealer E' CIL Address Description of Mobile Home: (Information is on your registration certificate) Make 71 Size r Ycar l (� S Serial # Year Purchased / Price (Less furniture & sales tax) Ii in Mobile Home Park: 7'a,ae of Park: Pa Space # If NOT in Mobile Home Park: Do you own the land on which the home is placed? YES NO Real Property description Owner of Land if you are NOT the Owner: Brief direction to location: Date Mobile Home Entered Mason County: % 9 Q Date you anticipate moving Mobile Home to another location: F_S If moved from a Mobile Home Park give: Name of Park: Space Your home will be placed on the tax rolls of Mason County. We would appreciate a prompt reply. Please feel free to contact this office if you have any questions. Personal Property Department 10 Owners Signature Date STATE OF WASHINGTON CERTIFICATE OF TITLE LICENSE NO. POW/USE CLASS MOD,YR. MAKE SERIES S BODY AJYLE f . %4854 5 M08 65 HILL C S OL/10 1. WHEN VE LE O SHIP CH NER(S)(SELLERS)RELEASE INTEREST BELOW. VEHICLE I.D.NO. MN) VALUE r CAE X X 1 1 090 GS INTEREST SIGNATURE RELEASES INTEREST CO.NO. REM,NO. DATE OF APPLICATION CODE NEW TITLE NO. X V 27 204 07 23 8d". 8220814 341 SIGNATURE RELEASES INTEREST SIGNATURE RELEASES INTEREST FLEET/EDUIP.No. SCALE wT, olD TITLE No. (IF A LIEN HOLDER IS TO BE SHOWN ON THE NEW TITLE,COMPLETE ITEM 4.) 2. NAME(S)AND ADDRESS OF NEW OWNER(S)(BUYERS) 7229204034 NAME NAME E SAME AS LEGAL OWNER BELOW � Q , �� / `�3 �o /-�q i � GJ/f ���� � ZIP CODE I ADDRESS S T (NEW OWNER(S)MUST TRANSFER TITLE WITHIN FIFTEEN(15)DAYS) E 3. R O� p DATE OF LE OR MILEAGE AS SHOWN rbTAL SELLPRICE G HANOE IN NE RSHIP ON ODOMETER OR VALVE OFF V VEHICLE W N E 4. LIEN HOLDER TO BE SHOWN ON THE NEW TITLE: R / T G KNECHTEL,CHARLES H _ L P 0 BOX 1039 NAME E G GIG HARBOR WA 98335 ADDRESS ZIP C DE A L 0 5 TITLE RTOOTHELNEW OWNER AND PROMPTLY MAIL THE NOTICE I OF CHANGE IN OWNERSHIP TO W THE DEPARTMENT OF LICENSING P.O.BOX 9909,OLYMPIA,WA 985D4. N E 6 R . WHEN LIEN IS SATISFIED, RELEASE INTEREST BELOW AND TRANSMIT BOTH COPIES OF THIS DOCUMENT WITH THE PROPER FEE TO AN AGENT OF THE DEPARTMENT OF LICENSING.THE TITLE 1 ((( ,��� WILL BE ISSUED TO THE OWNER. �/ I CERTIFY THAT THE RECORDS OF THE DEPARTMENT OF LICENS- c�L{�... -{,'��'Y X X ING SHOW PERSONS NAMED HEREON AS REGISTERED AND DIRECTOR, LEGAL OWNERS OF THE VEHICLE DESCRIBED. DE PARTME NT K)F LICENSING SIGNATURE RELEASES LIEN HOLDER INTEREST SIGNATURE RELEASES LIEN HOLDER INTEREST PLEASE NOTE:ADDITIONAL INFORMATION ON BACK TD 420-002(R 3/82) I I PLOT PLAN ADDRESS / ,0 90 X � " !' yC� 1V � CO/Z"L PERMIT NO. 4 L n f5 3 aK F'� Co �l ins La L A/vey�6P� a LEGAL P /a f S p4 y (p y ✓n aS o ff CO vh DESCRIPTION LOT BILK ADDITION a 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 ARID 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. n I INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20' C O 1 n-. v r 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 O ER(S) OF S1TE 6 STRUCTURE(S) (PRINT) _9 GT NATUR OWNER(5) OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT AS NOTED DATE SHELTON PRi ,INS � l I . -'-� ------ - -- - - - -- -- fir- --� 9 � �- i �-- � o Sa C� 1 r y - -�3�--- -- ------ i --- - - -- -- --- ----------- i