HomeMy WebLinkAboutBLD2022-00797 - BLD Application - 6/22/2022 o„'°1yG'r :1'i MASON COUNTY COMMUNITY SERVICES Permit No:�i A�Y=1�.' Lr D
e 1< PERMIT ASSISTANCE CENTER:
F1, •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL JUN,I ,,y c 615 W.Alder Street,Shelton,WA98584 J U N 2 2 2022
�) �(;�V : Vs; Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798Phone L7 v ""- ^ati� Belfair:(360)275-4467•Phone Elma:(360)482-5269
r,�r<��� 615 W. Alder Street
W BUILDING PERMIT APPLICATION
"SK .4} PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
4 NAME:Sean&Katherina Parker NAME:Suprema Homes
rQ MAILING ADDRESS:4715E Ellis RD MAILING ADDRESS.15315 501h Ave East
k() CITY:Shelton STATE: WA ZIP:98584 CITY:Tacoma STATE:W'a ZIP:98446
PHONE#I:9158417097 PHONE:253-331-1490 CELL: ..,.11
d 1 PHONE#2.91 544 92 546 EMAIL•infoPtsupremahomescom
M _a EMAIL:seankt@yahoo.com L&I REG#SUPREHt so7a3 EXP. 11/ /
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑
Z
NAME EMAIL '=
MAILING ADDRESS CITY STATE ZIP
PHONE CELL �..� W PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number)_319032290020 ZONING
LEGAL DESCRIPTION(Abbreviated) Undeveloped land FIRE DISTRICT Mason4 fire r+
SITE ADDRESS 471 se Ellis rd CITY Shelton
DIRECTIONS TO SITE ADDRESS Turn off cole rd onto Ellis and it's on the left about400 yards down. Z
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IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO Q SNOW LOAD psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION 0 REPAIR OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)Residence
IS USE: PRIMARY 0 SEASONAL ❑ NUMBER OF BEDROOMS 4 NUMBER OF BATHROOMS 2.5
HEATED STRUCTURE? YES (Whole Bldg)0 YES(Part[s]of Bldg)® NO❑
DESCRIBE WORK
SQUARE FOOTAGE:(proposed)
1ST FLOOR_2.641 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK So sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE l5.14._sq.ft.Attached❑ Detached® CARPORT sq.ft.Attached❑ Detached❑
MANUFAC N: *4 COPIES OF THE FLOOR PLAN REQUIRED*
M MODEL — L�
DTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER 0 / NEW 0 EXISTING 0 •
PLUMBING IN STRUCTURE? YES D NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO Tic, EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 4 TOTAL BEDROOMS 4
OWNER acknowledges that s ubmi ssion of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.!declare that I am the owner and I furth er d eclare that I am entitled to receive th is permit and to d o the work as proposed.I have
obtained permission from all the necessary parties,induding any easement h older or parties of interest regarding this project.The owner o r 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 reviewand inspection.This permit/applcation becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is suspended fora period of 180 days.
PROOF a • NUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERM • •TIO •F 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X 1�.,_ De ZZ ZL
�}! "ust be signed by the OWNER) Date '
Si��� fOWNER 4
DEPARTM AL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH i y f 1 I17>
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