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HomeMy WebLinkAboutBLD2022-00496 - BLD Application - 4/21/2022 MASON COUNTY COMMUNITY SERVICES Permit No l) CI 7�a�'�'��((I `f-S, PERMIT ASSISTANCE CENTER: rt RECEIVE D BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL � i •■h',,�`,,•k7 st y 615 W.Alder Street,Shelton,WA 98584 y ,? P Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone APR 2 1 Belfair:(360)275-4467•Phone Elma:(360)482-5269 2022 t �+ BUILDING PERMIT APPLICATION 615 W. Alder Street PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME:les5tt. P,t;.::.-1netentc. NAME: MAILING ADDRESS:4 t .. tc.e) Qd MAILING ADDRESS: CITY: `a901/4.2ill.i::(1 STATE: 13J Qt ZIP:Cr-M CITY: STATE: ZIP: PHONE#1: 360 CM'S-g240 PHONE: CELL: PHONE#2: EMAIL: EMAIL:`v�:I.:1ChCIA- zlae.ecyrivA\.CC Y1 L&I REG# EXP. / / otr PRIMARY CONTACT: / OWNER Jj CONTRACTOR 0 OTHER NAME ` e-55:c \I-o.d L EMAIL 'Rd o. 1-itol k o 4e$4•'e-@ gw+e.:1.l e.-.- MAILING ADDRESS (41 i F . 144e,Iraq Q.d CITY S�-I STATE wP `ZIP 41f `6'< W PHONE CELL 360 CI6'S- 61 2 G 4 J PARCEL INFORMATION: Z Q PARCEL NUMBER(12 Digit Number) 2 2 133 7 6 t O o I C{ ZONING 0 U.1 LEGAL DESCRIPTION(Abbreviated) 1A.I. 'I) ((c X ok 5 o6 5 4/113 kt-t Z FIRE DISTRICT SITE ADDRESS FLkC..C( CI"IY Lj 6C DIRECTIONS TO SITE ADDRESS 9.24, 1 11t on C h:r'`,F5 1 c^\t coat( l'A leA a 14-41rc.C( e.0,6 CAC S'oe.A nn I4 ' Z IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO N SNOW LOAD: psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF❑ STREAM 0 TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION❑ REPAIR 0 OTHER © itv...1_'x'11i.V1A- USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) 1ke:;3 ti A e1(1C_ie. IS USE: PRIMARY S SEASONAL 0 NUMBER OF BEDROOMS a NUMBER OF BATHROOMS L' HEATED STRUCTURE? YES(Whole Bldg)la YES(Part[si of Bldg)0 NO❑ DESCRIBE WORK R� \e. LPL.n' () Vsrb,,\,e_ `chi SQUARE FOOTAGE: (proposed) 1ST FLOOR SS>'IV 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❑ CARPORT sq.ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE X MODEL C.CO"L L( YEAR 1 q 7 9 LENGTH 6 0 WIDTH I'1 BEDROOMS BATHS 1.S SERIAL NUMBER p0.4 0 N cFS 7g, ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC M. SEWER 0 / NEW 0 EXISTING KI PLUMBING IN STRUCTURE? YES IX NO❑ If yes,attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO4 EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS oL TOTAL BEDROOMS a 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 APPLIC OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42) Ef-f - V Signature of OWNER(Must be signed by the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL �a PUBLIC HEALTH ?J` )I (holt.7 C(.94C-di` , ) . 1 t IA Z'o=Plueda6essaurg 4_Joloalw de;xoqui#wo�ge14/G/niputiywoo•a16006•1i mull:sd}btu 5 yl2 ) $ 5y 5 r 4T 4 !' i y ,?f J�r F r 4 � f ry a r.2ryIF_a' rs':r t1 2` 'j w r�'Scs ,v mil, # ,Wrr 5 - <E � t � 3'v-��.4+;f�,r -'�'ir T'�'�s.? .t" .Ss .� v�� i •� `�"s�ru,.,-"�'3.r -� r - _r. s: f `'- ✓/� � f:a ",fit ... '„' •v4. c0• a' i *' i -� .•v- .:��r..sn.l�rgrsrs9^xx,src �.r r � t ..� k �:+f- 7r.' ff- .t, `4-f,„ :- °{ '�G C }yam . .. 5'--t-4 y. *__ 3• - i vv,N d. w+�'.t '. 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