HomeMy WebLinkAboutBLD2019-00126 - BLD Permit / Conditions - 4/1/2019 MASON COUNTY COMMUNITY SERVIC�:s
PERMIT ASSISTANCE CENTER:
BUILDING •PLANNING-PUBLIC HEALTH*FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98684
-ex:(360)427-77'98 Phone
-9670 ext 352-I
Phone Shelton:(360)427
FEB W
Belfair.,(360)275-4467-Phone Elme:(360)482-5269
BUILDING PERMIT APPI ICATION' j Slcf-Zolf- 001-1
B U,
PROPERTY OWNER INFORMATION; CONTR CTOR INFORMATION:
NAME: I>A-u C AW6129,0-14- NAME: k��A P>i AJ e
MAILING ADDRES : A-IV r- AJ 7 MA ILIN( AI)DkESS�. ((Q:q A- 4 -
CITY-. STATE: Cc/,4 ZIP: 61�g�S- CITY: —,STATE' 1111A ZIP: Z-
PHONE#-1.(Zo' /,02 -7 7 PHONIE' tpc� 2r,!2- �,f-'ELL:
PHONE#2:- EMAIL :
L&I RE(��# EXP.
PIUMARY CONTACT'- OWNERk- CONTRACTG I F1 OTHER❑
NAME v f- EMAIL �
MAILIN ADD ESS. 4=Z 5 /+,,u C- CIT)' 6�-aZ 44 p I-VA STATE ZIP
�r IUC-
PHONE( '7'0 17'�6e> 7z CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 42 bOe - _ZONING
LEGAL DESCRIPTION(Abbreviated) �A TIRE DISTRICT.
SITE ADDRESS Z 10 L,?J, �PO —74 CITY Y
L) fft�-t
DIRECTIONS TO SITE ADDRESS G / 0 1 A)0�? -2�(u/ kl op--1 k
Z-c;,�:-7*-J kz- Eft"A A-uq�, A 1 11/0/11 U 19
IS THE, PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN Jll%: YES[] NOK
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that:I'7pl)):
SALTWATER[I LAKE [I RIVER/CREEK [I POND [I WETLA,'D [I SEASONAL RUNOFF [I STREAM El
TYPE 0FWQRK:- NEW Y' ADDITION [] ALTERATION[ RE-PAIR E] OTHER [I
USE OF STRUCTURE(Residence,Garage,Commercial(3ldg,E,te)
IS USE: PRIMARY) SEASONAL F1 NUMBER OF BEDROOI� NUMBER OF BATHROOMS
HEATED STRUCTURE? YES-(Whole Bldg)g YES (Parf[sl of Bldg) E1 I E]
DESCRIBE WORK,
SQUARE FOOTAGE: (Propose+existing)
I ST FLOOR 'L 04—sq. 11 2ND FLOOR sq.1 3RDFLOOI3. sq. ft. BASEMENT sq.P.
DECK sq. ft-. COVERED DECK. sq.ft. STORAGE- sq.ft-. OTHER sq.ft-.
GARAGE sq.ft. Attached[] Detached❑ CARPORT sq. ft-. Attached E] DetachedE]
MANUFACTURE'D HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN RE QUIRE D
-2 4--r
MAKE eARI�7-E7-7 i MODEL AA)9 LE YEAR *L-0/,8--LENGTH °S -
WIDTH Z BEDROOMS. BATHS <7-- SERIAL NUMBER
]ENVIRONMLi NTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC DK SEWER El NEWA EXISTING El
PLUMBING IN STRUCTURE? YESV NO El Ifyes, attach completed Water.Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES El NOk EXISTING SQ.FT.—(4-D
EXISTING BEDROOMS ,� ... PROPOSED BEDROOMS TOTAL BEDROOMS -3
OWNER acknowledges that submission of Inaccurate Information may result in a stop,v Drk order or permit revocation.Acknowledgement of such Is by
signature below. I declare that I am the owner and Ifurther declare that I am entitled to i eceive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,Including any easement holder or[;rties of interest regarding this project. The owner or legal
representative,represents that the information provided is accurate and grants employ of Mason County access to the above described property
and structure(s)for review and inspection. This permittapplication becomes null&vok f 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
R POILICATION OF 180 DAYS OF MORE WILL CAUSE HE APPLICATION TO BE EXPIRED. (MASON
COUNTY CODE 14.00.42)
x Signature of OWNER(Must be signed by the OWNER) Oate
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CON ITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
��
s
BENC.HMARK.• GROUND 0.SW COR �
LEIS = 100.0 (REL.) Ilk
L�
760.7 Cz
C41-1
YtZ! .11�.c�f t a
1
17R S(jl
Z o
a 171 i S
r
o r"
n
�� •-� � zw�y ¢x5° * lC�x'�� �m � � HE
r"n�.__ cz
m Q r��� ➢ o � sp��� np� � �a� �' iV'�o � � r � �� �'I �U
oX r
p r�r�p
� � U�
Ly �� X I ytst do z 0 N r.z oozp b�SEm IA (� II �
gMs HUM
5 m� H?�F'- CJ
yv S
m f, m
� � I
41
lot
e
t° -
PIA
4 ;
to
� A
' -
* . . -
14-4
rd
� W F
3
ii
s
!_
# � z
cps