HomeMy WebLinkAboutBLD2024-00602 Windows - BLD Application - 5/9/2024 MASON COUNTY COMMUNITY SERVICES Permit No:
PERMIT ASSISTANCE CENTER: t-] C I
•BUILDING•PLANNING•PUBCkC HEALTH•FIRE MARSHAL C
615 W.Alder Street,Shelton,WA 98584
Phone Shelton:(360)427-9670 ext 352-Faic(360)427-7798 Phone
Belfair.(360)2754467-Phone Erna:(360)482-5269 MAY
BUILDING PERMIT APPLICATION Alder ,
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:L t 'l NAME:
MAII�G ARES 1 - ' i' MAILING ADDRESS:
CITY. STA STATE: ZIP:
PH O 1: 7 _i�` - PHONE: CELL:
PHONE 42: EMAIL
EMAM' t 1- 3"5 j
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑
NAME - > �� EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) (�(� I �,'VV `' ZONING
LEGAL DESCRIPTIO (Abbreviated) FIRE DISTRICT
STTEADDRESS i9q l EnC
DIRECTIONS TO SITE ADDRESS V l.�
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 iharapply)c
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Ravide se,Garage Commerdal Bldg;Etc)
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
r HEATED STRUCTURE? YES(NhokBldw❑ YES(Paiifij ofRldg)❑ NO
DESCRIBE WORK
SOUARE FOOTAGE:(propwed)
1ST FLOOR sq.fL 2ND FLOOR sq.fL 3RD FLOOR sq.ft BASEMENT sq.$
DECK sq.fL 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: -
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER❑ / NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES❑ NO❑ Ifyas,attach completed Water Adequacy Form
PERRvIETERNOUNDATION DRAINS PROPOSED? YES❑ NO[] EXISTING SQ.FT.
EXLSTING 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 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 DE 14.08.42)
X
Signature of OWIIER st be s' ed b the. NER e
:-REPA1kTN9KNTAL REVIEW -: APPROVED",`= DAT =DENIED_- ATE'=TAGSINOTES/CONDITIONS
BUILDING DEPARTMENT -Z
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
'iretox https:Houtlook.live.com/mail/0/inbox/id/AQQkADAwATExADVm...
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5/4/2024.6:37 AM