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B -0 o \ � . $ . 0 - qm CD p % § 0k /F) ) 7M n } OL / 7 �O RR \ . cr k � /2 ( / I E CD CD 2 % o � $ $ � 7_ �_ RR 2 M7 o « o CD w � kko / / � § 0 : � CL-0fon E �k � / / cr � § k . � CD ® / / MASON COUNTY COMMUNITY SERVICES permit No: ��dI ����.� PERMIT ASSISTANCE CENTER: •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL 615 W.Alder Street,Shelton,WA 98584 RECEIVED Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone " 4' Belfair.,(360)275-4467•Phone Elma:(360)482-5269 1854 BUILDING PERMIT APPLICATION SEP 0 6 2017 PROPERTY OWNER INFORMATION: CONTRACTOR INFORMA'IWYV Alder Stggt NAME: r.�'i-- r--" I¢ ` NAME: MAILING DDRES : 15760 MAILING ADDRESS: CITY: STATE: ZIP: �$oL1f CITY: STATE: ZIP: PHON #I: "�(�f� � �f' PHONE: CELL: PHONE#2: EMAIL : EMAIL: L&I REG# EXP. PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑ NAME EMAIL MAILING ADDRESS CITY STATE ZIP PHONE CELL PARCEL INFORMATION: j PARCEL NUMBER(12 Digit Number) _ '� '� 3 o P S _ Tao 3y ZONING LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT SITE ADDRESS jL, 15 Sh&21,,100 d pd� �1;r1 CITY li DIRECTIONS TO SITE ADDRESS �— IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO ❑ IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF❑ STREAM ❑ TYPE OF WORK: NEW❑ ADDITION ❑ ALTERATION REPAIR❑ OTHER ❑ USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) IS USE: PRIMARY❑ SEASONAL ❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS HEATED STRUCTURE? YES(Whole Bldg) ❑ YES art[s1 of Bldg) ❑ NO ❑ DESCRIBE WORK SQUARE FOOTAGE: (propose+existing) 1 ST 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. ft. GARAGE sq. ft. Attached❑ Detached n -q CARPORT _ n ft 004-f UILDING RECEIVED s S Y 2 4 2017 w � 9' �'Z-� 615 W.Alder Street s e �F K- to s CHANGES AL fr " 'THESE PLANS � UST BE SUBMITc14ANGES FOR APPROV ECEIVED;. -�- � PRIOR TO PERFORMING WORK FOR JUL 2 5 2017 INSPECTION 15 W.alder Street . MUST MEET ALL CURRENT ;. . WASHINGMN STATE CODES rN i }