Loading...
HomeMy WebLinkAboutBLD2022-00732 - BLD Application - 6/8/2022 . G'$,f4 ' & MASON COUNTY COMMUNITY SERVICES Permit No:S 1,.gaiD oaol-007 ZR, . PERMIT ASSISTANCE CENTER: E. BUILDING •PLANNING•PUBLIC HEALTH•FIRE MARSHAL � �, p 615 W.Alder Street,Shelton,WA 98584 RECEIVED !l ` Phone Shelton:(360)427-9670 ext. 352•Fax:(360)427-7798 Phone JUN - U N N y"` Belfair:(360)275-4467.Phone Elma:(360)482-5269 ENVIRONMENT AL cb.avissBUILDING PERMIT APPLI@Vder Street HEALTH PROPERTY' OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: IlJ ji'f C!✓'/11 /CG> 4� NAME: 9r Qr?,5l MAILING A DRESS:/3 ' Z,a1 ' 4 /?c MAILING ADDRESS:_ Y62/ rt %/ CITY: 0,ea, �- E STATE: jt'fr ZIP: /2 CITY:j r-t.?el>Wftw STATE:WA ZIP:g %Z PHONE#1: 3( b yGf.e)-y/2de , PHONE:_ , e --f/Y ELL: PHONE#2: EMAIL ,0 '6y ,r,t`f-f30'i7. ,bf-e, -.1:0=4.0-., EMAIL: -A- VI9 %)Je /�Iie.,1d, C-e7tte L&I R G EXP. / / coti PRIMARY CONTACT: OWNER ©' CONTRACTOR❑ OTHER❑ NAME 7 'h,7 /,ice !-i EMAIL (�,� MAILING ADDRESS /.i ? %U CJ,c?% � CITY, ',✓� 3e''�c✓rj.ISTATE6 � ZIP PHONE CELL j —' 5,"2`-.sr-"7de PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) /77,FC .-52 'f? 2) -- ZONING LEGAL DESCRIPTION (Abbreviated) FIRE DISTRICT SITE ADDRESS f 4 ,�/�irffy- r CITY %- 1;-*if-- DIRECTIONS TO SITE ADDRESS 9 i�%/% ...- - >z r" - e.j e.:-~ _ 4e-,0-- AP -.e- .'.1. 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 T' ADDITION ❑ ALTERATION ❑ REPAIR ❑ OTHER ❑ USE OF STRUCTURE(Residence, Garage,Commercial Bldg,Etc.) je" / �.�v IS USE: PRIMARY SEASONAL ❑ NUMBER OF BEDROOMS ,Z-, NUMBER OF BATHROOMS 2 HEATED STRUCTURE? YES (Whole Bldg) [V YES (Part[s]of Bldg) ❑ NO ❑ DESCRIBE WORK jefoe..-it I �,e,=.4,Ie' SQUARE FOOTAGE: (proposed) 1ST FLOOR //i,2sq. 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❑ CARPORT sq. ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE ite,',` ,6:7,40 MODEL ,;Z5, ,a .5 YEAR ,7 Z 7., `Z LENGTH C. WIDTH a BEDROOMS 2) BATHS ,s-+ SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC SEWER ❑ / NEW Tr. EXISTING ❑ PLUMBING IN STRUCTURE? YES ' NO ❑ If yes, attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NO' EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS .?-^ TOTAL BEDROOMS 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 and 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 permit/application 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 ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 1B0 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON COUNTY CODE 14.08.42) X ignature of OWNS st be signed by the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL r PUBLIC HEALTH 1�Iz� cc I t� -s � SYMBOiSLEGENQ In IHN PHI . 0.-- rvoaoe+nm lit; En i-I a 1.!$ Bldg ti- a+m+�mmx goo�m:a � aa �a�� ® 1 d tt1r2.2. it 00 YR/1GllINNW9. W L;41-1 g 84E1ili y4 N yy tag iLL3. ^ wmrwr 5 ;. ..Hi,, rli Oil il a m op n I s R I it 1 II maaeawuc o C a`d 3O_ (A �T s em o N u. mp5 g qG H i - - •D tr;. IY�} .. r.��z m c>QmZ m A1 mI=o ,p Md�1AU -tr _' _- a^a 'l / , S Ll ...... ...,klx ' 0 aauooy)S 3N - a * Z m > Qn2 o r m im, g�.N N Z. ,d D zoZ o°ocn.Z 93 o rck0 m 0 c'rr a p I, Z o N�O R> m v .amp y, - .1 N N o`,� • n C}B N g Z ccnn P • � J ��$ 'z N m Z O C:$ Z it 17 g f ao 5 t f'` . y 11 -cr g Printed Frs M?gsoi� ,.a.Bnt f $k •. , 1-1110.eu luuiu iV dbUUtk C.HUHLY.1.1141A