HomeMy WebLinkAboutBLD2016-00392 Final Replacing Windows - BLD Permit / Conditions - 10/28/2016 co
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cO-�"� MASON COUNTY PERMIT NO. I O L40
i DEPARTMENT OF COMMUNITY DEVELOPMENT 361 2
BUILDING•PLANNING•FIRE MARSHAL
WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352
Mason County Bldg. I11,426 West Cedar Street (360)275-4467 Belfair ext.352
txc1 PO Box 279, Shelton,WA 98584 (360)482-5269 Elma ext. 352.E
BUILDING PERMIT APPLICATION 1 �('��V
, er'n,..� A. �D
OWNER INFORMATION: CONTRACTOR INFORMATIO : 'S W ?016
NAME:Qn ; if- JZ; 11 16 S NAME: Alder St,, t
MAILING ADDRESS: 17,12 Co S L� Q Q.)e4 t5-F MAILING ADDRESS:
CITY: Au hU f 1'1 STATE:U)pl. ZIP: 4" CITY: STATE: ZIP:
PHONE--)S3-�-31-7Sq 7 CELL:_QU.D -'7/ :S -0 IL PHONE: CELL:
EMAIL:AQ n h o I tom; 11 ld�C"n ca S n P 4 � EMAIL:
L&I REG# EXP.
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER) l a g- L/y- OOOav FIRE DISTRICT J
LEGAL DESCRIPTION(ABBREVIATED): i tZ o �,ovr L.v 4 (o 'T�y y� 41I— !�
SITE ADDRESS / / C/,SOn jZd CITY
DIRECTIONS TO SITE ADDRESS&4J Z t3 11&A---,Qi 6 cv A"30 d awn
IS PROPERTY WITHIN 200 FT:
SALTWATER N LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF❑ STREAM❑
DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT OF THE PROJECT-GREATER THAN 14% YES❑ NO K
TYPE OF JOB: NEW ❑ ADDITION ❑ ALTERATI01�' REPAIR❑ OTHER ❑
USE OF STRUCTURE(RESIDENCE,GARAGE ETC.) `
IS USE: PRimARYn SEASONAL NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS
DESCRIBE WORK r"4 o r, p P.e n
SOUARE FOOTAGE:
1 ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR N R sq.ft. BASEMENT sq.&
DECK sq.ft. COVERED DECK sq.ft.STORAGE sq.ft. OTHER sq.ft.
GARAGE '? o sq.ft. ATTACHED❑ DETACHED ®, CARPORT sq.ft. ATTACHED❑ DETACHED❑
MANUFACTURED H FORMATION: *4 COPIES OFT OOR PLAN
MO
BE OOMS 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 a nspection.This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or construction rk is suspen Ulu[ - eriod of 180 days.PROOF OF CONTINUATION OF WORK IS BY MEANS OF
INSPE=T10INAC TY T APPLICATION OF 180 DAYS WILL VALIDATE THE PPLICATION.
X
�Sig_nature pf A plicant / ate
X J >Yi a= S f/f�¢ly(S OWNER 1 REPRESENTATIVE /CONTRACTOR
Print Name (CIRCLE TO INDICATE)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT