HomeMy WebLinkAboutCOM2023-00043 - COM Application - 8/1/2022 MASON COUNTY COMMUNITY SERVICES Permit No.&m ton- I w4C/
PERMIT ASSISTANCE CENTER: RECEIVED
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98W
Phone Shelton:(360)427-9670 ext.352•Fax.(360)427-7798 Phone
Belfair.(360)275-4467•Phone Elma:(360)482-5269 MAY 10 2023
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: r Street
NAME:ANSTEY,SHANK A NAIVE:MASTEC NETWORK SOLUTIONS
MAILING ADDRESS:P o sox 26 MAILING ADDRESS:22263 68th Ave S
CITY:UNION STATE:WA ZIP:98592 CITY:I(1T STATE:WA ZIP:98032
PHONE#1: PHONE:(503)580-5964 CELL:
PHONE#2: EMAIL:William.erotton0mastec.com
EMAIL.: L&I REG#MASTENS876KN EXP. 5 /14/23 -
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER❑+
NAME N..Oroulmr Wmim Pcs.uC by i%W"°c'° Cnl*use im,by w.s.m oMA Nehwk swvim EMAIL Cheisea@gmanetworkservices.00m
MAILING ADDRESS 590 tat Ave South,11705 CITY sNtue STATE WA ZIP 96104
PHONE (2os)48"371 CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 3-22-32-33-90061 ZONING Rural Residential
LEGAL DESCRIPTION(Abbreviated) PCL 1 OF BLA s11-06 PTN OF LOTS 1,3,4 OF SP et t49 S SW,S 3a/12 FIRE DISTRICT
SITE ADDRESS 100 East Union Heights Place South CITY Union,WA 98592
DIRECTIONS TO SITE ADDRESS See T-1 sheet of construction drawings
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO O SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (check all thatcppty):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW ADDITION 0 ALTERATION REPAIR OTHER E wireless tower modification
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)Existing wireless communication lower and facility
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Parr/s)ofB/dg)❑ NO❑
III DESCRIBE WORK Eligible facilities request...see attached project description
SQUARE FOOTAGE: (proposed)
I
1 ST FLOOR 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.fL
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC❑ SEWER❑ / NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES❑ NO 0 Ijyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO❑+ 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
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 permitlapplication becomes null 8 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
Agent for GMA Network Services,Agent for Crown COUNTY CODE 14.08.42)
Castle USA Inc.See attached Property---w
X Owner Authorization. - 3/23/2023
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH