HomeMy WebLinkAboutCOM2017-00059 Modular Bldg - COM Application - 5/31/2017 MASON COUNTY COMMUNITY SERVICES Permit No: M 7�WVJ 1
PERMIT ASSISTANCE CENTER: Recr'd:
•BUILDING•PLANNING•FIRE MARSHAL
615 Alder St-Shelton,WA 98584 RECEIVED
Phone:e:360-427-9670 exL 352 Fax:360-427-7798
hip://www.co.mason.wa.us/community dev/
ENVIRONMENTAL BUILDING PERMIT APPLICATION MAY 3 12017
HE TY OWNER INFORMATION: CONTRACTOR INFORMATION: 15 W. der Street
NAMEWASHINGTON STATE DEPARTMENT OF CORRECTIONS NAME: MYLES VIXIE,FORMA CONSTRUCTION
MAILING ADDRESS:7345 LINDERSON WAY SW MAILING ADDRESS:PO BOX 11489
CITY:TUMWATER STATE:WA ZIP:98501 CITY:OLYMPIA STATE: WA ZIP: 98508
PHONE#1:(360)725-8327 PHONE:(360)754-5788 CELL: (206)396-6973
PHONE#2: EMAIL:MYLESV FORMACC.COM
EMAIL: CMHOLIEN(a)DOC1.WA.GOV L&.I REG# FORMACC8780R EXP:�2-f�
CONTACT PERSON: OWNER® CONTRACTOR❑ OTHER/BELOW❑ _ r
NAME: CORY HOLIEN MAILING ADDRESS:7345 LINDERSON WAY SW
CITY: TUMWATER STATE: WA ZIP: 98501 PHONE:(360)725-8327 CELL: (360)890-0246
EMAIL: cmholien0DOCI.WA.GOV
PARCEL INFORMATION:
PARCEL NUMBER(12 DIGIT NUMBER) 12318-00-60000 ZONING LTCF
LEGAL DESCRIPTION(ABBREVIATED) 67-SERVICES-GOVERNMENTAL FIRE DISTRICTNORTH MASON RF
SITE ADDRESS 3420 NE SAND HILL RD CITY BELFAIR
DIRECTIONS TO SITE ADDRESS SOUTHWEST FROM BREMERTON NATIONAL AIRPORT ON NE SANDHILL RD
IS PROPERTY WITHIN 200 FT: (CLrcd all rlmr app4Y:
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
IS THE PROJECT WITHIN 300 IT OF SLOPE(S)GREATER THAN 14% YES[] NOIR
TYPE OF WORK: NEW ® ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER n
USE OF STRUCTURE(Residence.Garage.Commercial 13Mg.Etc.)MOBILE OFFICE
IS USE: PRIMARY® SEASONAL❑ NUMBER OF BEDROOMS 4 NUMBER OF BATHROOMS 0
HEATED STRUCTURE? YES(Whole Bldg)o YES(Part[s]of Bldg)❑ NO❑
DESCRIBE-WORK MODULAR BUILDING TO BE PUT IN PLACE ON A FLAT GRADED SITE
SOUARE FOOTAGE:
1ST FLOOR 1152 sq.ft. 2ND FLOOR N/A sq.li. 3RD FLOOR N/A sq.ft. BASEMENT N/A sq.ft.
DECK NIA sq.ft. COVERED DECK N/A sq.ft.STORAGE N/A sq.ft. OTHER N/A sq.ft.
GARAGE N/A sq.ft. ATTACHED❑ DETACHED❑ CARPORT NIA sq.ft. ATTACHED❑ DETACHED❑
milf 410 M0DU I'ma, LDI N NFORMATION: *4 COPIES OF THE FLOOR PLAN REOUIRED
MAKL-MODERN B"LDING SYSTEMS I,NC.MODEL 24'x 48'MOBILE OFFICE YEAR 2006 LENGTH 48'
WIDTH 24' BEDROOMS 4 BATHS 0 SERIAL NUMBER 808-809 2004.01.2A&B
OWNER acknowledges that 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 or owner's legal representative.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 legal
representative,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 permittapplication becomes null&void if
work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of
180 days.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT
APPLICATION OF 180 DAYS WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42)
X
JJSigliature of OWNER Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PERMIT SPECIALISTS Intake B Appmvcd&Ready for Pick-Up:
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