HomeMy WebLinkAboutBLD2019-00613 Bulkhead - BLD Application - 5/7/2019 ON COUNTY COMMUNITY SERVICES Permit No: �O�q v— `' `,z
MASON
- PERNITA55I5TANCECEN7ER: Recv'd: /�
' •BUILDING•PLANNING•RRE MARSHAL - C��
615 W.Alder St-Shelton.WA 98584 //r-
f Phone:360-427-9670 exL 352 Fax:360 427-7798 `/ RA ,V�D
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BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
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NAME: ROW,
(- NAME: '��` `Sr vv, f1t"�6 6f,f a &,5 =f'r'�
MAILING ADDRESS: .."•t- u MAILING ADDTFESS�dt '' S�i 0
CITY: V JJ ---STATE: A ZIP: 4 _$0� CITY: STATE: �! Z[P: —/
PHONE#1: s I[a iSti 9 �( t 4f 1 PHONE: •�2 t' ,4 �CELL: t Z •y
EMAIL: t 1✓�
PHONE#2: L&I REG i# EXP.
i EMAIL: y /�E t"n r^
CONTACT PERSON: OWNER❑ CONTRACTORA OTHER/BELOW❑
NAME: MAILING ADDRESS:
CITY: STATE: ZIP: PHONE: CELL:
EMAIL:
PARCEL INFORMATION:
l ZONING
PARCEL NUMBER(12 DIGIT NUMBER) FIRE DISTRICT
i LEGAL DESCRIPTION(AB$REVeTEDJ
SITE ADDRESS Y�l If`�' (Y CITY v
DI ECTIONS TO SITE ADDRESS r4 C t�` ✓ �
�O�D
IS PROPERTY WITHIN 200 FT: (Check all tlmrappry):
SALTWATER& LAKE❑ RIVF.R/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%i, YES(] NO
TYPE OF WORK. NEW ❑ ADDITION ❑ ALTERATION❑ REPAIR® OTHER El-
USE OF STRUCTURE(Residence,Cmzge,Cmnieraal Bldg Etc) ��iL�f•��
IS USE: PRIMARY�`j SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BAqT11R00
HEATED STRUCTURE? YES(Whole Bldg)❑ �E S(Pan[s]ppf Bldg)❑ NO❑
I.v h,�i• t.r«�lte� ;/r-t� �� r�r(t�4 DESCRIBEWORKSOUARF.FOOTAGE:1STFLOORsq.ft. ?NDFLOOR__sq.ft. 3RD FLOOR sq.R BASEMENTDECK sq.ft COVERED DECK sq.It STORAGE sq.R OTHER
sq.It ATTACHED DETACHED ElGARAGE sq.fr. ATTACFIID❑ D1 CACHED❑ CARPORT ❑
MANUFACTURED HOME INFORMATION. -4 COPIES OF THE FLOOR PLAN REQUIRED
MAKE_,MODEL_.___ _YEAR LENGTH
WIDTH BEDROOMS_, BATHS SERIAL NUMBER
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 or owner's legal representative.I further
declare that 1 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 permiUapplication 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 CONTINUA ON OF WORK IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT
A ILIC TION O 18 A ILL C E THE APPLICATION TO BE EXPI D.(MASON COUNTY CODE 14.08.42)
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Signature of 0 NER a
DEPARTMHNTAI,REVIEW APPROVED DA DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT S 7 ZD
PLANNING DEPARTMENT
FIRE MARSHAL
PERMIT SPECIALISTS Intake By. Approved&Ready for Pick-Up:
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APPROVED
MASON COUNTY DCD PLANNING
SITE PLAN REQUIRED TO BE ON SITE
CHANGES SUBJECT TO APPA
By /jpTJ ,t3 Date