HomeMy WebLinkAboutBLD2013-00904 Final MFG Home - BLD Permit / Conditions - 10/10/2013 . .._.�. . .
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MASON COUNTY PERMIT NO.
DEPARTMENT OF COMMUNITY DEVELOPMENT
BUILDING•PLANNING•FIRE MARSHAL
_ WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
_—_ Mason County Bldg. 111,426 West Cedar Street (360)275-4467 Belfair ext.352
rasa PO Box 279, Shelton,WA 98584 (360)482-5269 Elma ext.352
BUILDING PERMIT APPLICATION
OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: Tao NAME:
MAILING ADDRESS: P, a MAILING ADDRESS:
CITY: t-+ STATE: Wdk- ZIP: 22M CITY: STATE: ZIP:
PHONE CELL: PHONE: CELL:
EMAIL: {kc R.ea tB'�a2e- • Calms L EMAI :
L&I REG# EXP.
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER) Z - 77 - Op I ZO FIRE DISTRICT
LEGAL DESCRIPTION(ABREVIATED) : C
SITE ADDRESS LAE _ CI
DIRECTIONS T S ADDRESS
IS PROPERTY WITHIN 200 FT:
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF❑ STREAM❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES❑ NO)ir
TYPE OF JOB: NEW ❑ ADDITION ❑ ALTERATION❑ REPAIR❑ OTHERX E,N�59
USE OF STRUCTURE(RESIDENCE,GARAGE ETC.)
IS USE: PRIMARY Ll SEASONAL ❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
DESCRIBE WORK l nctL O Y"1 X 1 1 YICt Man
SQUARE FOOTAGE:
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq. fL
GARAGE sq.ft. ATTACHED ❑ DETACHED ❑ CARPORT sq.ft. ATTACHED ❑ DETACHED ❑
MANUFACTURED HIM INFORMATION: *4 COPIES OF THE FLOOR PLAN
MAKEfi.QMODEL YEAR ( LO LENGTH S�,
WIDTH 205 EDROOMS 3 BATHS SERIAL NUMBER
OWNER/BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or contractor. I further
declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary
parties,including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for
review and inspection.This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or if construction work?iss�ende a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF
IN ECTI I TIVITYIS MIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
x la -('C)-- 13
nature o pf n Date
x OWNER/ REPRESENTATIVE /CONTRACTOR
Print a (CIRCLE TO INDICATE)
DEPART NTAIL REVIEW-.. APPROVED DATE DEMTEA DATE TAGWNNIOTESICONDT,TIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL