HomeMy WebLinkAboutBLD2018-00372 Deck - BLD Application - 4/17/2018 �vi� aopr, MASON COUNTY COMMUNITY SERVICES
PERMIT ASSISTANCE CENTER: Perm it No:
•BUILDING•PLANNING .PUBLIC HEALTH.FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584 RECEIVED
-s
Phone Shelton:(360)427-9670 ext 362•Fax:(360)427-7798 Phone
Belfair(360)275-4467•Phone Elma:(360)482-5269 APR A�D17 2018
1634
DING
B BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: U<Cm NAME: C o q; 101 � AA Idt4y,
G MAILIN_ AD MESS: 3UU C Ra:hKc MAILIN AG DDRESS:
CITY: STATE: L-)I ZIP: *�LAq CITY: 0,6119"6L STATE: W ZIP: c i
PHONE#1: cea 5y-a PHONE: CELL:
PHONE#2: EMAIL :- r/d
EMAIL: L&I REG# 6APZT5 Ff:,1 R(, XP.of ll,Zc�U
PRIMARY CONTACT: OWNERk CONTRACTOR OTHER,❑
NAME 77l-t ,11 e EMAIL w,+'e rL7'Ct. 60,•.7
MAILING ADDRESS CITY /CZ STATE A.),J- ZIP_, Ll/
PHONE CELL
PARCEL INFORMATION: I I Ue-iA __--
PARCEL NUMBER(12 Digit Number) a 17 �n — [� ZONINGTk_}-�Z CI I ,fV1 C
LEGAL DESCRIPTION(Abby ed}. FIRE DISTRICT S
SITE ADDRESS_: ,W C /U.1'�I P t� II2—�" CITY - -
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO
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,g OTHER ❑
USE OF STRUCTURE(Residence,Garage,Comnrerclal Bldg,Cstc�
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? hole Bldg) ❑ S(Par of Bldg) ❑ NO I-1
DESCRIBE WORKV,L�fi a ,t.trl G ( � Ci(� L2 ('QAQXL, l o6ft
SQUARE FOOTAG : (propose+exlstr
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DEC sq. ft. COVERED DECK sq.ft. s .ft. OT sq.ft.
KAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Atlached❑ Detached❑
MANUFAC' OME INFO *4 COPIES OF THE FLOOR PLAN RE,E,QUWXI D-
MA_
MODEL YEAR LENGTH
IDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL REAL
SEWAGE/SEWER S is SEPTIC❑ SEWER❑ / NEW EXISTING ❑
PLUMBIN STRUCTURE? � YES ❑ NO❑ lfyes, attach completed Water uacy Fornt
PERT iTER/FOUNDATION DRAINS PROPOSED? YES ❑ NO[] EXISTING SQ.
TING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
1y%
acknowledges that submission of inaccurate Information may result in a stop work order or permit revocation.Acknowledgement of such is by
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
permission from all the necessary parties,Including any easement holder or parties of Interest regarding this project. The owner or legal
ative,represents that the information provided Is accurate and grants employees of Mason County access to the above described property
ture(s)for review and Inspection. This permittapplication becomes null&void If work or authorized construction is not commenced within 160
construction work is suspended for a period of 180 days.
F OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
MIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
4- is- Zo18
3 Signature of OWNER(Must be sinned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT DE C 571L t
PLANNING DEPARTMENT n ax) I y)G l j �' r 1
FIRE MARSHAL
000
PUBLIC HEALTH 0