HomeMy WebLinkAboutBLD2019-00916 Windows - BLD Application - 8/20/2019 MASON COUNTY COMMUNITY SERVICES Permit No:
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 l y' j ",:••.,
Be/fair:(360)275-4467•Phone Elma:(360)482-5269 ` E•, (, i "
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMA't-iON;�
NAME: e e wt v` NAME:
MAILING ADDRESS: 32 S 1J ?A S♦ MAILING ADDRESS:
CITY: Yec-Ae- STATE: W4 ZIP: &91o3 CITY: STATE: ZIP:
PHONE#1: 21)G B- I Y PHONE: ' CELL:
PHONE#2: EMAIL : /
EMAIL: L&I REG# EXP.
PRIMARY CONTACT: OWNER R" CONTRACTOR❑ OTHER❑
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL NMI all n1h1t;
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 7000( 6 ZONING
LEGAL DE5CRIPTION(Abbreviated) s1 'Ppltitt *(D Lod: 16 FIRE DISTRICT
SITE ADDRESS 76 Jr Z LW rZA CITY
DIRECTIONS TO SITE ADDRESS
r
AS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: S❑ NO e-
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) IrCS�dGti.[�
IS USE: PRIMARY ❑ SEASONAL [- NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS_
HEATED STRUCTURE? YES(IVhole Bldg) 19� YES(Part(sj of Bldg] ❑ NO ❑
DESCRIBE WORK A�JZMA i Gi
SOUARE FOOTAGE: (propose+existing) V'V Ck,,�e r ----—
I ST FLOOR 2D sq. ft. 2ND FLOOR i` sq. ft. 3RD FLOOR sq. ft. BASEMENT sq. ft.
DECK (77 sq. Il. COVERED DECK sq. ft. STORAGE_sq. 11. OTHER `- sq. ft.
GARAGE .-I sq. ft. Attached❑ Detached❑ CARPORT _-- y 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 R / NEW ❑ EXISTING
PLUMBING IN STRUCTURE? YES [v] NO ❑ If yes, attach completed Water Adequacy Form
PERIMETER&OUNDATION DRAINS PROPOSED? YES ❑ NOe-- EXISTING SQ.FT.
EXISTING BEDROOMS�_ PROPOSED BEDROOMS I TOTAL BEDROOMS
OWNER acknowledges that submission of inaccurate information may result in a stop worn 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.1 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)
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
-7�5 -E- Fr'vj"o&Aiolj I�pok
171a- Twvsx hfc;coL C:�:
pLAN1 RECEIVED
177iJ7 A � .ALL
SETBACKS A
FROM NE F E MEASURED AUG 2 O 2019
' PROJECTION OF NE BHEST 615 W.UILDING Alder.Street
715'
New LIT Jowe
�{ f
APPROVED
6 3 MASON COUNTY DCD PLANNING
SITE PLAN REQUIRED TO BE ON SITE
\ CHANGES SUBJET TO APPROVAL
8Y l DaW