HomeMy WebLinkAboutBLD N/A Mobile Home - BLD Application - 9/24/1986 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
PERMIT NO.
M6 MAIL ADDRESS CITY&STATE ZIP PHONE
OWNER Z A qcid 7tS..at -; 3Gr
DIRECTIONS
TO JOB SITE ,r C / �Y_L,
LEGAL
DESCR. ,
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE �Z2116
BUILDING
CLASS OF NEW ADDITION ALTERATION --TREPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
BEDROOMS DECKS CARPORT NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
BATHROOMS TOTAL SQ.FT. GARAGE CONDITIONING.
NO.OF STORIES BASEMENT ATTACHED THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT
COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR
TOTAL SQ.FT. FIREPLACE DETACHED ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED.
PERMANENT SHORELINE
SEASONAL
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 BUILDIN TMEN'T. APPROVAL FROM THE BUILDING DEPARTMENT.
OWNER DATE _ X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVENo DEPARTMENT YESPPROVENO BUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT 0-7
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDINGGROUP PRE-INSPECTION
SHORELINE
PLANNING
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLICATION ACCEPTED BY I PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION ^
TOTAL `
IBY CASH CK MO �
PLOT PLAN
ADDRESS PERMIT NO.
0
= o
LEGAL R. Y7
DESCRIPTION LOT BLK ADDITION u
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.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
S ,I
.10
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.
-/(- t I
NAME(S) OWNER(!) OF SITE 6 CTUR (!) (PRINT) IGNATVRE OF OW ER(!) OR AqTAORI D REPRESENTATIVE
DO NOT WRITE BELOW THIS L/NE
APPROVED
DISTRICT AS NOTED DATE
ICHRISTMASTOWN PRINTING
A ` STPE 'A. SO C0 !! S SE S OR
NES
E'!IEF rr,PUTY
PLEASE S11PPLY THE !TnLU".1"V'.f1
REr-APPI"":n VP'ln '107IL7 6'0"T :
4 Z/ 'ylor7
Owners Name:��C,�,e Za.. V - Tel le #
C,7 )
Mailinn Address -� 44 4, lk g-CA-)
Previous Mobile Home Owners Name & Address
Description of Mobile Home: (Inforretion is on your reqistrat4on certificate)
Ad - Size Make —
Year Serial
Year Purchased Price (Less furniture & sales tax) $ e)e7
If locating in Mobile Home Park:
Narie of Park: Space #
If NOT in I'lobile Home Park:
Do you own the land on whi^6 tpe home is placed? Yes, "jo
'oo Real Property description PW Z
Owner of Land if you are NOT the Owner.
Brief direction to location:
Date Mobile Home Entered/4a/son Count.y:
Date you anticipate movina Mobile Home to another location:-
If moved from a Mobile Home Park c,iive:
Name of Park: i mace #
Your home will be placed on the rolls of r-lason County. !,!e would appreciate a
prompt reply. Please feel free to contact this office if you have any questions
at all .
Very truly yours,
Helen Naser
Personal Property Department".-
Owners Sir!natuW----