HomeMy WebLinkAboutBLD2022-00745 - BLD Application - 6/13/2022 s��'°' MASON COUNTY COMMUNITY SERVICES Permit No: 6 I 2Z CO 1 i.S
° PERMIT ASSISTANCE CENTER:
BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
I 615 W.Alder Street,Shelton,WA 98584 j +�,
2 ^ I Phone Shelton:(360)427-9670 ext 352•Fax (360)427-7798 Phone 1
G st Belfair:(360)275-4467•Phone Elma:(360)482-5269 E e
g to ��a� I
BUILDING PERMIT APPLICATION //R./
PROPERTY`OWNER INFORMATION: CONTRACTORR INFORMATION: • 1., ?(i22
NAME:JO.^�a7t-car- Tv NAME:(&I r—e �(J• 4Ci'I
�'r
MAILING ADDRESS:750 a_ nu t uW}M RA•MAILING ADDRESS:' O) S SJ ,tr,F_{
CITY: rr. STATE: ZIP:Q�C f.$' CITY:j w("J� STATE:I Jf� ZIP:01 f� 5 t
PHONE#1: 7 " PHONE - 93.4I''9bCELL:
PHONE#2: EMAIL:
EMAIL:3o,.TUtW5 ,No I.f f7!"l L&I REG#l05 Q9O3 P EXP•/L-/!-L/ .I
PRIMARY CONTA T: OWNERAL CONTRACTOR 0 ER
NAME_ ( �ei EMAIL d! .COr'N''
MAILING ADDRESS -L0/L17.EVA =Ci CITY / ' fir' ATE ZIP S
PHONE CELL 1 "�i 7 7-c 6 Q N5/
IRO A V rM
PARCEL INFORMATION: ' �' `N�/'AL 1
PARCEL NUMBER(12 Digit Number) al 302."3 I'"qa►3 I ZONING PA. HEALTH
LEGAL DESCRIPTION(Abbreviated)L.115 p 2af 9,:m.eaGa W�,)-��7'liG�.W ARE DISTRICT N�SOrI
SITE ADDRESS 250 XI Trf/c . v , f PA J C TY i,
DIRECTIONS TO SITE ADDRE S 'e . e.Y' - Z1.✓a p - Li,rI-
oA 'i I^vil IJ Pk,-r .- ►t vn e3r r - net 12.15
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO$ SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apple):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW lif ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0
(�USE OF STRUCTURE(Residence,Garage,Commercial, ) Bldg,Etc.) ResI ce_ff�
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS '7 NUMBER OF BATHROOMS 1.6
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Penis]ofBldg)X NO❑
DESCRIBE WORK Net.) tVLSti
SQUARE FOOTAGE:(proposed)
•
1ST FLOOR273 7 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER Sii rsq. ..t J
GARAGE 7 fq sq.ft. Attached Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: S qlull -Cool0
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW XISTING ID
PLUMBING IN STRUCTURE? YES NO❑ Ifyes,attach c mpleted Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES NO EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 9 TOTAL BEDROOMS i i/
i
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 APPLICATI•N OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
6 -/y- ate
X �,,
Signature. •WNER(Must be signed by the OWNER) Date
' DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH \c� 1 111)u l( 1 cr Gi l
4
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