HomeMy WebLinkAboutBLD10362 Mobile Home - BLD Application - 3/31/1981 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
426-5593
DATE ISSUED
PERMIT NO. f y 3
OWNER NAME MAIL ADDRESS CITY&STATE ZIP PHONE
F •� S 43OX 3 12 u /�
DIRECTIONS
TO JOB SITE — l 3 �e LL-T 6
LEGAL (❑ SEE ATTACHED SHEET)
DESCR..CO ✓ 0/1.1s L/3rC
" NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
CONTRACTOR
s &.
USE OF
BUILDING
/`1 A17— o� ��Ji't%�'.S
Class of work: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR Cl MOVE ❑ REMOVE
Describe work:
P,1,4c ' x
c9 cn 3 leg-)
Valuation of work: $�/ n oo PLAN CHECK FEE PERMIT F4 c?c
SPECIAL CONDITIONS:
BEDROOMS {DECKS CARPORT ❑ NO
BATHROOMS— 1 TOTAL SO. FT GARAGE ❑
ATTACHED ❑ SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING
NO. OF STORIES BASEMENT ❑ / OR AIR CONDITIONING.
TOTAL SO. F 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 OR WORK IS
SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER
1 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 i
SEASONAL ❑ FLOODPLAIN f7
Firm
E.D. NO. S.E.P.A. fJ
By Special Approvals IN OUT YES APPROVED NO
Lic. No. Date ZONING
PLAN
OWNERS AFFIDAVIT HEALTH DEPT.
P KS
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
n conformance t4erewith. MOTOR VEHICLE PERMIT
A I ATI N ACCE TED BY PLANS CHECK BY APPROVED FOR ISSUANCE
Own Date tt Ll_ eat
BY
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
LOIS SCOTT
ASSESSOR
T H E M A S 0 N C O U N T Y A S S E S S O R
DARRYL CLEVELAND
CHIEF DEPUTY
PLEASE SUPPLY THE FOLLOWING INFORMATION
REGARDING YOUR MOBILE HOME
Owners Name:,J,grrrt- � Tel e # N9-4/4�T-
Mai I ing Address 1511R4'�2 20
Previous Owners Name $ Address N1A
Description of Mobile Home: ( Information is on your registration certificate)
Make Z/,6&-?e5_y Size - - - o��X 170 ------- -
Year Serial
Year Purchased S-/ (Less furniture & sales tax) $
If in Mobile Home Park:
Name of Park• /V�i�' Space #
If NOT in Mobile Home Park: /
Do you own the land on which the home is placed? YES NO
Real Property description 7,✓"'a C'o//,ems 1p�r PLAT
Owner of Land if you are NOT the Owner: AI
Brief direction to location: o xv ?
�ccToP P .
Date ile Home Entered Mason County:
Date you anticipate moving Mobile Home to another location: os91&8- 3 -f %ks
If moved from a Mobile Home Park give:
Name of Park:. 6 Space # _
Your home will be placed o the rolls of Mason County. We would appreciate a
prompt reply. Please feel free to contact this office if you have any questions
at all .
Very truly yours,
Helen Glaser
Personal Property Department
X _ 311 17wel#-
Owners Signature Date
I�