HomeMy WebLinkAboutBLD2020-00585 MFG Home - BLD Application - 5/21/2020 • MASON COUNTY COMMUNITY SERVICES Permit No:
PERMIT ASSISTANCE CENTER:
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584
Phone Shelton:(36Q)427-9670 ext.352•Fax:(360)427-7798 Phone
Beltalr:(360)275-4467•Phone Elma:(360)482-5269 RECEIVED
BUILDING PERMIT APPLICATION
MAY 7
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
15 W. A.-Jet, 6u 'at
NAME: Q Y ^n3Zv(P NAME:
MAILING ADDRESS: I t9 . MAILING ADDRESS:
CITY:T(1CC tM A STATE:I ZIP: CITY: STATE ZIP:
PHONE#1:,451 31.J /.mot,'FC7 PHONE:
PHONE 0 R-5 EMAIL :
EMAIL: C" L&I REG# EXP.
�! PRIMARY CONTACT: OWNER[A CONTRACTOR❑ OTTER❑
NAME et ' EMAIL -kQ 11S 4� I4U- =�V4
MAILINGADD ESS l_[�g 14f►J' AIVP _S, CITY 't/4CUfM bl S TE t)ll C ZIP
PHONE CELL 1K a 3 .914 js o
PARCEL INFORMATION: Is
PARCEL NUMBER(12 Digit Number) 4 d o / -:� CIA 000 30 ZONING
LEGAL DESCRIPTION(Abbreviated) P T IV NJ W g W 1 }-41 Q• 4 FIRE DISTRICT
SITE ADDRESS 44 .T I I)A1/4:PA) Ai y- ' CITY -<;'A{Z
DIRECTIONS TO SITE ADDRES
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: NEV-S. ADDITION❑ ALTERATIOON E] ,/REPAIR❑ OTHER
J ❑
USE OF STRUCTURE(Residence, Garage,Commercial Bldg,Etc) e-'C I(/'Pm (_e
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS p~L NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg YES(Part[,]of Bldg) ❑ NO ❑
DESCRIBE WORK /M ll) M F 61 1 2
SQUARE FOOTAGE: (proposed)
1 ST FLOOR A 0 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*
MAKE S K. V MODEL YEAR�je LENGTH &C
WIDTH�� BEDROOMS /_ BATHS SERIAL NUMBER / /6 146 X
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 1K SEWER❑ / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES JZ NO ❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NO❑ EXISTING SQ.FT.
EXISTING BEDROOMS--a— 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
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.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
COUNTY CODE 14.08.42)
x - .7 ? C)
e
Si-9 nature of OWNER(Must i ne the OWNER) Date
DEPARTMENTAL REVIEW APPROVED PATF DENIED DATE TAGS/NOTE NDITIONS
BUILDING DEPARTMENT p(r-3 3&cicd
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
J
REC C`�!E D
MAY 2120
615 W.Adder'Sheet
APPROVED
MASON COUNTY DCD PLANNING �
SITE PLAN REQUIRED TO BE ON SITE G - - - -
CHANGES SUBJECT TO APPROVAL By-- t' Date 6112i'a - +
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IL N
PLANNING
Q
PLANNING:
TOPOGRAPHY PROFILE: ALL SETBACKS ARE MEASURED
N FROM THE FURTHEST
PROJECTION OF THE BUILDING
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Direction: Scale: Approval: for orrice use
Building Permit number: Building:
Owner/Applicant: Date of Planning:
application: Env. Health:
Parcel Number:
SECTION 17 TO'
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2200030 2200060
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2200050
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2200020 S 23/11
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2300051 2300010 ;4 cl !1.
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TOPOGRAPHY PROFILE:
RECEIVED
L_ Wr
MAY 2 12020
RC
Building 061A Af * Street Direction: Scale: Approval: foroffice use
Building:
Owner/Applicant: Date of Planning:
Parcel Number:
application: Env. Health:
I