HomeMy WebLinkAboutBLD2016-00299 REROOF - BLD Permit / Conditions - 4/11/2016 0 Oj 0
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iv ,.��cU� t MASON COUNTY COMMUNITY SERVICES
PE Permit No:
/
• BUILDING• PLANNING. FIRE MARSHAL IZecv'd.
615 W. Alder St - Shelton, WA 98584 RECEIVE
Phone Shelton:(360)427-9670 ext 352 Fax:(360)427-7798
854 '` Phone Belfair. (360)275-4467 Phone Eltna:(360)482-5269 APR , f 2016
BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: LO NAME:
MAILING ADDRESS: I tl 3An O U Y)OI MAILING ADDRESS:
CITY: TATE: ZIP: 9 g CITY: STATE: ZIP:
PIZONE 41: 2�) k — r — bq PHONE: CELL:
PHONE#2: EMAIL
EMAIL: L&I REG# EXP.
CONTACT PERSON : OWNER
,�E ._CONTRACTOR ❑ *OTHER/See Below ❑
*NAME: MAILING ADDRESS: _
CITY: STATE: ZIP: PHONE: CELL:
EMAIL:
PARCEL INFORMATION: I'lf,i °JT J Ili
PARCEL NUMBER(12 Digit Number) 'y e[y 2-'Z 2 ('Z�� ZONING ShehV,%IAG+
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS `� �� I�W U �a ' CITY cj
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S) GREATER THAN 14%: YES[] N016
IS PROPERTY WITHIN 200 FT: (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.)
IS USE: PRIMARY ❑ SEASONAL ❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES (Whole Bldg) ❑ YES (Part[s]of Bldg) ❑ NO ❑
DESCRIBE WORK ` t — f-O N %A/ '1,
ee.a007- (? I c-- V (Valuation/Project Bid Amount: �, )
SQUARE FOOTAGE: COm 3 uQ 7_ 00 0 c/ )
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*
MAIL ODEL YEA
WIDTH BEDROOM BATH SERIAL NU R
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 or owner's legal representative. 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 IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT
APPLICATION OF 180 DAYS WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON COUNTY CODE 14.08.42)
Sign a of OWNER Date
11
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PERMIT SPECIALISTS Intake: I*I l Approved&Ready for Pick-Up:
Visit us on-line: http://www.co.mason,wa.us/community_dev/ Rev. 112712016 by JBN
Ci(f od ;( ,�