HomeMy WebLinkAboutBLD2017-01241 Patio - BLD Application - 11/21/2017 -- MASON COUNTY COMMUNITY SERVICES permit No
PERMIT ASSISTANCE CENTER:
t •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
.1:
615 W.Alder Street,Shelton,WA 98584 RECEIVED
Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
Belfair(360)275-4467•Phone Elma:(360)482-5269
BUILDING PERMIT APPLICATION NOV 21 2017
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: Alder Street
NAME: w.r L«lcy NAME:
MAILING ADDRESS: '7a I E °o ,r- CT MAILIN DRESS: ,
CITY: 1411S STATE: W ZIP: qj!'M CITY: "STATE: ZIP:
PHONE#1: 'ot 510 OS A Z K k PHONE: CELL:
PHONE#2: 1 15"1 1,la EMAIL :
EMAIL: t�:Mc��u�•' �S (�ar-wl L&I REG# EXP.
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑
NAME 4-- La. y EMAIL '� e S�r��'dr5 C Aync���•�'a^+
MAILING ADDRESS CITY STATE ` ZIP
PHONE a5-5 9'05_ t7 `I A CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) �22►� s, - o0o i� ZONING
Q'es;a�tl� �q,
LEGAL DESCRIPTION(Abbreviated) _A'1c\a 4 V C 1 'A L.a I� FIRE DISTRICT
SITE ADDRESS 22 I E O1 y►,n?cC C CITY A0vil
DIRECTIONS TO SITE ADDRESS X����q 1 w n.Q I,a'W'aIZ V- ar,Q 04 A vii 3
k�waY� /�k�CSo. L-a� 1 or aelf c.owrSC
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 X ALTERATION ❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) G 0 vp,(4 �11,` .P rQ(r F cA j-&N
IS USE: PRIMARY O� SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg) \❑ YES(Pants]of Bldg) ❑ NO 4
DESCRIBE WORK C�VP--C& 0 y-V door p�4c, rgrA,, o+ na � O �ack. �1n{O ax15t �Y+v�SP
SQUARE FOOTAGE: (propose+existing)
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK J `1 O 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 RE D*
MAKE - MODFL YE.AIL.--- —� - LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC ❑ SEWER V / NEW ❑ EXISTING
PLUMBING IN STRUCTURE? YES❑ NO rA If yes, attach completed Water Adequacy Form
PERIMETERNOUNDATION DRAINS PROPOSED? YES ❑ NOM 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