HomeMy WebLinkAboutCOM2023-00067 Retaining Wall - COM Application - 7/13/2023 MASON COUNTY COMMUNITY SERVICES Permit No: oZ D�CP
PERMIT ASSISTANCE CENTER:
•BUILDING-PLANNING-PUBLIC HEALTH-FIRE MARSHAL Cb r"R E C E I V E Q
615 W.Alder Street,Shelton,WA 98584
Phone Shelton:(360)427-9670 ext 352-Fax:(360)427-7798 Phone
Belfalr.(360)275-4467-PhoneEtma:(360)482-526.9JUL 13
3^ 2023
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATIO
i e Street
NAME: ICR S KI 1q, PUS NAME:
MAIL ADDRESS: 0 E• 0( \1 MAILING ADDRESS:
CrTY: i n STATE:V ZIP:_q q 59 CITY: STATE: ZIP:
PHONE#1: &O I- l9-/2 2-5 PHONE: CELL:
PHONE#2: ♦ EMAIL:
EMA L PEG# EXP. 5 C
PRIMARY CONTAC ' OWNER CONTRACTOR❑ OTHER❑ ��
NAME 1 -/: .- EMAIL
MAILING ADDRESS \ CITY STATE ZIP v
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) a a 3 a- 3�1 -�10D►a zoN1NG z
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS `1'i�17 C -( .�; .i Iyr, i CITY (j n w n
SECTIONS TO SITE ADDRESS
IY Lh vG-c �j 1 i;n 1 hu � � a►�
r T
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: (Csmkall that apply);
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Ars dm r,Garag4 Com =uil Bldg,Bra)
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS N@PER
OF BATHROOMS
HEATED STRUCTURE? YES(whokBldg)❑ YES(Part[4 I/ O❑ .
DESCRIBE WORK c-�' 0 &A-`►I In
SOUARE FOOTAGE:(propasr4
1 ST FLOOR sq.fL 2ND FLOOR sq.fL 3RD FLOOR sq.fL BASEMENT sq.fL
DECK sq.fL COVERED DECK sq.ft STORAGE sq.fL OTHER sq.IL
GARAGE sq.it Attached❑ Detached❑ CARPORT sq.fL Attached❑ Detached❑
MANUFACTURED HOAU INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
7TIH�__
MODEL LENGTH BEDROOMS BATHS SERIALNUMBER
ENVIRONMENTAL HEALTH: -
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER❑ / NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES❑ NO❑ Ijyer,attach completed Mater Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO[] EXISTING SQ.Fr.
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
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 structrre(s)for review and inspection.This permitlapplication becomes null&void If work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 1 B0 days.
PROOF OF CONTINUATION W O ORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 0 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE DARED.(MASON
f COUNTY CODE 14.08.42)
X
r roD R(Must be signed bythe OWNERI Date
R1 VIEWr=-' APPROVED::-=DA... DEI D DATE= TAGS/NOTES/CONDITTONS=<:
BUILDING DEPARTMENT
PLANII-UNG DEPARTM=
FIRE MARSHAL
PUBLIC HEALTH
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