HomeMy WebLinkAboutForklift Loading Ramp - COM Application - 6/5/2017 MASON COUNTY COMMUNITY SERVICES Permit No:
PERMIT ASSISTANCE CENTER: Recv'd:
Y ~ .BUILDING•PLANNING•FIRE MARSHAL
615 W.Alder St-Shelton,WA 98594
Phone:360-427-9670 ext.352 Fax:360-427-7798
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BUILDING PERMIT APPLICATION _
PROPERTY/OWNER�INFO�RMATION: . CONTRACTOR INFORMATIO\:
NAMES l p�� 1 --- NAME:
MAILING ADDRESS: MAILING ADDRESS:
CITY: STATE: ZIP: CITY: STA CELL:
PHONE#1: PHONE:
PHONE#2: EMAIL:
EMAIL: L&I REG# EXP.
CONTACT PERSON: OWNER❑ CONTRACT=L-1
BELOW
NAME: A rQ.w S* u' MAILING ADD f v r t s 3
CITY: t1 4t STATE:_ OEG PHONE: CELL: lr,o�i-7Ct8- 63
EMAIL: t4LJ rCrf{}rn brti
PARCEL INFORMATION: TO BE KEPTr�
PARCEL NUMBER(12 DIGIT NUMBER)_
ZQNINQ THE
MR LRFPQF-
LEGAL DESCRIPTION(ABBREVIATED) CE
SITE ADDRESS ITYI '--
DIRECTIONS TO SITE ADDRESS
IS PROPERTY WITHIN 200 FT: (Check aft that aftv):
SALTWATER❑ LAKE❑ RIVERfCREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
1 1S THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14% YES[] NO❑
TYPE OF WORK: NEW (ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER ❑ -
119E OF STRUCTURE(Residence,Gumge.Commercial Bldg,Etc.)
IS USE: PRIMARY❑ SEASONAL[: NUMBER OF BEDROOMS
NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Part[s]of Bldg)❑ NO nc
DESCRIBE WORK S Uff?` I .n t' OF (�4 L/ � fA,I,r 1- 1 U ` d � '
SQUARE FOOTAGE:
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT_ sq ft.
DECK sq.tt. COVERED DECK_ sq.ft.STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. ATTACHED❑ DETACHED El CARPORT_ sq.ft. ATTACHED❑ DETACHED
MANUFACTLTRED HOME INFORMATION: •a COPIES OF THE FLOOR PLAN REOUIRED
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
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.1 further
declare that I am entitled to receive this permit and to do the work as proposed.I have obtained permission from all the
1 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 WO IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT
i APPLIC OF 1 DAYS WILL USE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42)
x Signature of OWNER t Date
I
OPEP—MIT
TAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
EPARTMENT
EPARTMENT
AL
CIALISTS Intake By Appmvcd&Ready for Pick-Up:
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