HomeMy WebLinkAboutBLD N/A Mobile Home - BLD Application - 5/26/1987 BUILDING PERMIT APPLICATION
MASON COUNTY
DEPARTMENT of GENERAL SERVICES
P.O. BOX 186 SHELTON, WASHINGTON 98584
426-5593 DATE ISSUED
PERMIT NO.
OWNER NAME MAILADDRESS CITY&STATE ZIP PHONE
DIRECTIONS
TO JOB SITE
PARCEL LEGAL r _
NUMBER DESCR. 6� L _ -11
NAME MAIL ADDRESS CITY&STATE LICENSE NO. ZIP PHONE
CONTRACTOR
USE OF
BUILDING
CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE
WORK ✓
DESCRIBE
WORK
l 'Z CO c
EDROOMS DECKS / CARPORT 1L NOTICE
SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR
ATHROOMS_� TOTALSQ.FT. GARAGE CONDITIONING.
NO.OF STORIE 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 ANY TIME 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 BUILDING PA��RTTMENT. APPROVAL FROM THE BUILDING DEPARTMENT.
X'OWNER "e'- TE '�� X BY DATE
FOR OFFICE USE ONLY
DEPARTMENT YESPPROVEDJO DEPARTMENT YES DEPARTMENTBUILDING VALUATION
HEALTH PUBLIC WORKS FEE
PLANNING FIRE BUILDING PERMIT
D.O.T. BUILDING PLAN CHECK
SPECIAL CONDITIONS BUILDING GROUP PRE-INSPECTION
SHORELINE
WOODSTOVE
PLUMBING
MECHANICAL
STATE BUILDING FEE
STATE SURCHARGE
APPLlcAplDbkAcCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION
TOTAL
BY CASH CK MO �) �'
RPSUSOR
T ! F "" AS0 C0. !jf1TY ^ SSE S SOI
pf MLAS JTTS
el!lEF rr"!1TY
PLEASE SUPPLY THE
REO.ARD I!n VO'!n. ."'07 I L7 @'0�T ;
Owners Name: �� i�r ,�D y�� Tel e
i
Nailing Address 3Qyq <S; :E 1/6A-,:�, l2gA& AD.
AM7`OX—ALA R t2 WA
Previous lobile Home Owners Name rx Address 8/ & Z e2ge Neg4 wA.,
Description of Mobile Home: (Infomation is on your registration certificate)
MakeAz Size / Sl
Year f 4� Serial # &/'iJ
Year Purchased�Price (Less furniture & sales tax) $_tea-Db
If locating in Mobile Home Park:
Naate of Park• �� Space #
If °.1OT in Nobile Home Park:
Do you own the land on which the home is placed? Yes_ mo
Real Property descrintion��/Z / LA DiPis L 07
Owner of Land if you are CLOT the Owner:_ _
Brief direction to location:rJ,A/-N RDgp td Gl>Z_/Z 6/ k //` /= FAQ
SI—A r10 Al L ,EST ,4AN,D ,'r nF vF 5DkD
Date mobile Dome Entered Vason County: � R
Date you anticipate moving Mobile Home to another location: V/,a
If roved froma Mobile Tome Park Rive:
"•'ame of Park:_6LN&C- /40& , 5 Al-16A D R - Space # 10
Your hone will be placed on the rolls of flason County. !!e would appreciate a
nrompt reply. Please feel free to contact this office if you have any cuestions
at all .
Very truly yours,
Helen Glaser
Personal Property Department-,:
Owners Sinnature ----�—