HomeMy WebLinkAboutBLD2019-00070 BLD2019-00067 - BLD Application - 1/25/2019 MASON COUNTY COMMUNITY SERVICES Permit No: �
PERMIT ASSISTANCE CENTER: ` M � `7
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL 1/ ( `o( (-P /
4;0 615 W.Alder Street,Shelton,WA 98584
Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone
Belfair.•(360)275-4467•Phone Elma:(360)482-5269 R�
BUILDING PERMIT APPLICATION GENE
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATI 252019
NAME: Jason Zack NAME:Owner his
MAILING ADDRESS: Po Box 2240 MAILING ADDRESS: t �t
CITY: Shelton STATE: Wa ZIP:98584_ CITY: STATE: ZIP:
PHONE 41: 360-490-6711 PHONE: CELL:
PHONE#2: 360-426-7386 ENTAIL :
EMAIL: zack jasongoutlook.com L&I REG# EXP. /_/
PRIMARY CONTACT: OWNER Ok CONTRACTOR❑ OTHER❑
NAME Jason Zack EMAIL zack.jason@outlook.com
MAILING ADDRESS Po Box 2240 CITY Shelton STATE Wa ZIP 98584_
PHONE CELL 360-490-6711
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number)42122-12-00020 ZONING RR-10
LEGAL DESCRIPTION(Abbreviated)Tr 2 ofNl/2 NE FIRE DISTRICT
SITE ADDRESS 1070 E Eagle Point Drive CITY Shelton
DIRECTIONS TO SITE ADDRESS From Hwy 101 turn on Emile Point Drive. At approx.. one mile, turn right into driveway
marked with address.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YEKNO ❑
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 Y� ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE (Residence, Garage,Commercial Bldg,Etc)Residence
IS USE: PRIMARY/6& SEASONAL ❑ NUMBER OF BEDROOMS 7J NUMBER OF BATHROOMS 2.`IZ
HEATED STRUCTURE? YES (Whole Bldg)ck YES (Part[s]of Bldg) ❑ NO ❑
DESCRIBE WORK New residential home construction
SQUARE FOOTAGE: (propose+existing)
1ST FLOOR1W _sq. ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT 5 81 sq. ft.
DECK sq.ft. COVERED DECK 136 sq.ft. STORAGE q_sq.ft. OTHER sq. ft.
GARAGE sq. ft. Attached❑ Detached❑ CARPORT 66(o sq.ft.Attached❑Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: wi to -00 4
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW$. EXISTING ❑
PLUMBING IN STRUCTURE? YES64 NO ❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YESO- NO❑ EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
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 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
COUNTY CODE 14.08.42)
01/23/2019
X
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
PUBLIC HEALTH
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