HomeMy WebLinkAboutBLD2020-01083 SFR - BLD Application - 9/16/2020 MASON COUNTY COMMUNITY SERVICES Permit No: f/I ed GrV•DI DbY2
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:(360)275-4467•Phone Elma:(360)482-5269
oBUILDING PERMIT APPLICATION SEP 16 2020
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:6 1 cJ W. Alder Street
NAME:Me r1Vf4 I IN 5 NAMEeda �✓`Tr DTI��
MAIL G ADDRE S: MAILING AQQRESS:
CITY r TATE:�.r�ZIP4423,10
CITY: A
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PHONE#1: 3&0 ,4TJ • 91 0 PHO t QIO'1 CELL: M;
PHONE#2: EMAIL:^I^N SVbV �—
EMAIL!M A P!j. K tfl�A t L&I REG#&GC4 !Crr / EXP.IL/QLl
PRIMARY CONTACT oWNER&J-" CONTRACTOR} OTHE bAs� p4p r
NAME 4` EMAIL
MAILING DRESS CITY 4beejGSTATE %4Q ZIP
PHONE 6 CELL — ^"1E
PARCEL INFORMATION:
012
PARCEL NUMBER(12 Digit Number) 1 ZZ d$5-`17-CA>-7 ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT AA•S&A
SITE ADDRESS tLAO E CAd'Ot 4W C-T CITY A 1Xy Wx
DIRECTIONS TO SITE ADDRESS _s '3p`Z 10-ift 1ST Rwi 1"aT 'kn*cQ
�x��.•-Oc�IA 14�T—� ��T' �� �wL�
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN I4%: YES[] NO X
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (checkan that appiy):
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.) rC.16 I AG^sG
IS USE: PRIMARY,200SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS Z.
HEATED STRUCTURE? YES(whoteBug)e YES(Pwifgofmdg)❑ NO❑
DESCRIBE WORK
SQUARE FOOTAGE:(propose+e=ang)
I ST FLOOR 15 [sq.ft. 2ND FLOOR &5 sq.ft. 3RD FLOOR_ sq.ft. BASEMENT 0 sq,ft.
DECK .0d sq.ft. COVERED DECK C 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/10n✓i a MODEL WAyLI�I y YEAR 2,OrL.O LENGTH4,C2
WIDTH 2 _BEDROOMS BATHS Z SERIAL NUMBER
ENWRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC.J�f' SEWER❑ / NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES;e NO❑ Ifyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NQel' 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 1 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 ail 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 permitlapplication becomes null&void if work or authorized constriction 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 JAORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
X COUNTY CODE 14.08.42) Ub U n
t'V- ZZ U 1RJ "'JJJZ�
Signature of-OWNER(Must be signed by the OWNER I Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT til
PLANNING DEPARTMENT
FIRE MARSHAL
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Sw 2.Olci 00LOS —S - RECEIVED .
202 V oo a Lo SEP 16 2020
615 W. Alder Street
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FROM THE FURTr4FST
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