HomeMy WebLinkAboutCOM2020-00054 2 Modular Classrooms - COM Application - 5/20/2020 MASON COUNTY COMMUNITY SERVICES Permit No:
PERMIT ASSISTANCE CENTER:
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL !" n(,
615 W.Alder Street,Shelton,WA 98584 Er-
Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
Belfair(360)275-4467•Phone Elma:(360)482-5269 MAY .t�1 fl '-i
BUILDING PERMIT APPLICATION 5 VV.
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PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATI • �'
NAME:Shelton Presbyterian Church NAME:ACC-U-Set Construction D'N G
MAILING ADDRESS:1430 Shelton Springs Rd MAILING ADDRESS:PO Box 725
CITY:Shelton STATE:WA ZIP:98584 CITY:Washougal STATE:WA ZIP:98671
PHONE#I:253-306-1259 PHONE:360-835-2437 CELL:
PHONE#2: EMAIL :tammy@accusetconstruction.com
EMAIL:rlburkhalter@msn.com L&I REG#ACCUSC•ss3PN EXP.
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER❑
NAME Rick Burkhalter EMAIL rlburkhalter@msn.com
MAILING ADDRESS 2412 Walker Park Rd CITY Shelton STATE WA ZIP 98584
PHONE CELL 253-306-1259
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 420122190002 ZONING
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LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 1430 Shelton Springs Rd CITY Shelton
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO ❑ SNOW LOAD: psf
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 ❑Modular classrooms(2)
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc)Church classrooms
IS USE: PRIMARY ❑ SEASONAL ❑ NUMBER OF BEDROOMS 0 NUMBER OF BATHROOMS 0
HEATED STRUCTURE? YES(Whole Bldg) ❑ YES(Part(sj of Bldg) ❑ NO ❑
DESCRIBE WORK Move and install 2 used 28 x 64 modular buildings purchased from the Shelton School District onto PT ponywall foundations
SQUARE FOOTAGE: (proposed)
I ST FLOOR 1.792 each sq.ft. 2ND FLOOR 0 sq.ft. 3RD FLOOR 0 sq.ft. BASEMENT 0 sq.ft.
DECK 1,280 sq.ft. COVERED DECK-0 sq.ft. STORAGE 0 sq.ft. OTHER 0 sq.ft.
GARAGE 0 sq.ft. Attached❑ Detached❑ CARPORT 0 sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: WO *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE Blazer Industries MODEL YEAR 2008& I ll q 8 LENGTH 64' bb4—L-\�
WIDTH 28' o BEDROOMS 0 BATHS 0 SERIAL NUMBER oo1ee4-we081e75601 302 end CC1464.2MK9B%'20321
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC ❑ SEWER❑ / NEW ❑ EXISTING ❑
PLUMBING IN STRUCTURE? YES ❑ NO ❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NO❑ EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 0 TOTAL BEDROOMS 0
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknovdedgement 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.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.
PRO F OF C TINUAT ON OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
P M AP ICATIO OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
COUNTY CODE 14.08.42)
X
Ignatur f OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT (/l
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
PLANNING: MAY 20
�G ALL SETBACKS ARE MEASURED 615�Va Mw
FROM THE Foster
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THE BUILDIN
PROJECTION OF Williams
Architects
601 W.Raikoad Are.
P.O.Box 102
Shelton,WA 98584
Ph:(360)426-0511
FAX:(360)426-2926
-mail:
mail(rQfosterwiliams.com
Prc)ect Number
N01'2035"E 672.68
Project Title
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152.04
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