HomeMy WebLinkAboutCOM2020-00078 - COM Application - 9/1/2020 MASON COUNTY COMMUNITY SERVICES Permit No: {o
PERMIT ASSISTANCE CENTER:
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584
Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone
Belfair.(360)275-4467•Phone Elms:(360)482-5269
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:_ Mason County Public Works NAME: W ldwood Carpentry LLC
MAILING ADDRESS: 100-W Public Work Drive MAILING ADDRESS: 6801 N 11th st
CITY: Shelton STATE: -_ZIP: oRs84 CITY: Tanmmn STATE: ZIP: ggW013
PHONE#1: 360-427-9670 ext 092 Ai�9d PHONE: CELL: 360-390-8863
PHONE#2: EMAIL: woodenspar@gmaii.com
EMAIL: LCastilloeco.mason.wa.us L&I REG# EXP. /
PRIMARY CONTACT: OWNER❑ CONTRACTOR Ed OTHER❑
NAME narrin rrckum EMAIL wnndan p;u(&gmnil rnm
MAILINGADDRESS 6081 N 11thst CITY Tacoma STATE WA ZIP98406
PHONE CELL (3sn)-4c) -PtAr,4
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 4200 2-21-9001 0 ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 100-W Public Work Drive Shelton 98584 CITY Shelton
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO❑X SNOW LOAD:_,psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVERICREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg Era.)
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
DATED STRUCTURE? YES(Whole Bldg)❑ YES(Tart[s]of Bldg)❑ NO❑
DESCRIBE WORK
SQUARE FOOTAGE:(proposed)
I ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BAS�(� sq.ft,
DECK sq.ft. COVERED DECK sq.ft.- STORAGE sq.ft. OTHI�Z '`7500 .sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑X
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERLALNUMBER -
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER❑ / NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES❑ NO® Ifyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO X❑ EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS None 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 pernission from all the necessary parties,Including any easement holder or parties of interest regarding this project The owner or legal
representative,represents that the infornaton provided is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This pernittapplicabon 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
/J COUNTY CODE 14.08.42)
X/Z"//Al&� /;W
ignatureOf OW ZER(Must be signed bvthe OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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