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HomeMy WebLinkAboutBLD2021-00438 Windows - BLD Application - 3/26/2021 MASON COUNTY COMMUNITY SERVICES PERMIT ASSISTANCE CENTER: •BUILDING •PLANNING•PUBLIC HEALTH•FIRE MARSHAL RECEIVED 1A 15 W.Alder Street,Shelton,WA 98584 on Iton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone MAR 2 6 2021 Belfair:(360)275-4467•Phone Elma:(360)482-5269 BUILDING PERMIT APPLICATION 615 W. Alder Street PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: C' ,"00- i �HL��(,e- NAME: /� b G/�ow- , fie4m 'Cf MAILING ADDRESS: MAILING ADDRESS: jp/ C Ci.1�Z L.YAI ' y CITY: STATE: ' A ZIP: CITY: t' r✓ STATE:_ZIP: 9�C PHONE#1: 0 D �, PHONE:;GQ Y�0-/.41 CELL: 31 PIr/4,e tf�• y qp EMAIL : "1' 5f. .)rrPHONE#2: C �� L&I REG# ' 1�-5G gEXP. - /4' EMAIL: D . PRIMARY CONTACT: n OWNER, � CONTRACTOR❑ OTHER❑ NAME 1 - RC k�'�tiiN EMAIL t'a MAILING DD SS i+ bA'(4U CITY E' STATE ZIP PHONE b y(1 CELL 44 2 N 07- i PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) C� Z #IDGO?�3Z ZONING �� LEGAL DESCRIPTION(Abbreviated) /r✓IfcSn�✓E%G/� r FIV DISTRICTR&0IN 120ak& r/ SITE ADDRESS /6 y Gc 1,h6 tvN bg CITY J/jG`' r, /'/ DIRECTIONS TO SITE ADDRESS 4,6at 'C' / WNI1y-Paf NIV&A5 3 6'0 I<r/To �S,dt�ANGc� ff L73101 GG S IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO 0� SNOW LOAD: psf 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 ❑ ADDITION ❑ ALTERATION REPAIR❑ OTHER ❑ USE OF STRUCTURE Residence,Garage,Commercial Bldg,Etc. [L G�l 0/ , IS USE: PRIMARY SEASONAL ❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS u!t a HEATED STRUCTURE? YE$k(iKhole Bldg) YES (Partt[,s]r of Bldg) ❑ NO ❑ DESCRIBE WORK 174l A3 1; N400 j N /�/( MIW044 Cs�M /�AGL &,JAem/t'eS SQUARE FOOTAGE: (proposed) 1ST FLOOR 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 MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC ❑ SEWER❑ / NEW ❑ EXISTING ❑ PLUMBING IN STRUCTURE? YES ❑ NO ❑ If yes, attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NO[] EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS 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 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) X G Date Signature of, MER Must be signed by the OWNER) DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH • MASON COUNTY COMMUNITY SERVICES Permit No. 21G1 a0';20 " do-;�25 PERMIT ASSISTANCE CENTER: .BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL RECEIVED 615 W.Alder Street,Shelton,WA 98584 Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone Belfair: 60 27�5 44EPERMIT (32-5269 MAR 2 3 2020 • (',(� BUILD APPLICATION PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: Ll-tn@t NAME: VY1�C.��L�ti! wOOc�S NAME: �y��rt-rh �/owt-c � � t •ti MAILING ADDRESS: -1-(-y MAILING AD SS: //5 0:j 9 7'S r CITY: 5f,,Ct�o, STATE:W 6n- : CITY: Tazd STATE: t:,-k ZIP: `I8`/Y PHONE#1: clo+ q`fo 8.3Lfq PHONE:A53 1$8 a60:jL- CELL: g)t?gq©/Z(s^ PHONE#2: a YO d' EMAIL: mIkecr- EMAIL: met v`[ c lL.e-1 id V�c.kd v CD L&I REG# f f/e R 6P 1�T14(�XP. La�(t/d4 PRIMARY CONTACT: OWNER❑ CONTRACTOPV t�OTHER❑ NAME % ih5e�� EMAIL /Xelhe—Ieucn;e<e•.I.ar+te�c��re�'�.Crc+y� MAILING ADDRESS !/3-0 57tift CITY ?AC-ol,.f STATE 4i ZIP 9, &5r PHONE '"Lj-1'W - CELL 6 �- PARCEL INFORMATION: QQ PARCEL NUMBER(12 Digit Number) I I -1- 55 - 000 32 ZONING LEGAL DESCRIPTION(Abbreviated) FIRE DIS/T//RICT SITE ADDRESS (z�/ FL�s n ca.� DY`(t!e CITY Sk-e(7�✓` �^- DIRECTIONS TO SITE ADDRESS 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 apply): SALTWATER V LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑ P"fe-ok USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS HEATED STRUCTURE? YES(Whole Bldg)❑ YEAS(Part/sl ofB/dg)❑ NO❑ DESCRIBE WORK ek,, ,r-Gk D-es c r5 /Salk Der—K- 34ma e r SQUARE FOOTAGE: (proposed) I ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft. DECY-29Q sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft. GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑ MANUFACTU FORMATION: *4 COPIES OF THE FLOOR PL QUIRED* MAKE MOD YEAR ENGTH WIDT BEDROOMS HS SERIAL R ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC�fl SEWER❑ / NEW❑ EXISTING PLUMBING IN STRUCTURE? YES ❑ NO❑ If yes,attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO❑ EXISTING SQ.FT. n EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS OWNER acknowledges that submission of inaccurate information may result In a stop work order or permit revocation.Acknowledgement of such is by J 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) X �3 � a3 �aoao Signature of OWNER(Must be signed by the OWNER) Date