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Home My WebLink AboutBLD2018-00205 Addition - BLD Application - 3/2/2018 MASON COUNTY COMMUNITY SERVICES G� PERMIT ASSISTANCE CENTER: Permit No�Its ZD 18 -C.62-0-5 •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL t, ` , i 615 W.Alder Street,Shelton,WA 98584 I r L V Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone n1/1R 0 2 2018 185 �Yr Be/fair(360)275-4467•Phone E/ma:(360)482-5269 615 W. Alder Street B I LD I N G BUILDING PERMIT APPLICATION PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME S Vo.y\ �Uv�1of V'�'S�� NAME: S�f<�rcJr s�\c0,� MAILING ADDRESS: MAILING ADDRESS: -\C-� 6— CITY: STATE: ZIP: CITYG(C" N- STATE:c-vf� ZIP:Cb'-�b PHONE#1: PHONE:-'Slav-mill o1a\`D\CELL: PHONE#2: EMAIL :!a; EMAIL: L&I REG#S-�Q ��"S,C�a`b EXP.-/Q0 PRIMARY CONTACT: OWNER ❑ CONTRACTORS OTHER❑ NAME 5al \.h EMAIL MAILING ADDRESS e 1TY `o tr—'t^ STATE�f _ PHONE CELL PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) p 0 " C-DO" 0 0 C��J ZONING ) �Sj `ao� LEGAL DESCRIPTION(Abbreviated) V,YNN 1 o FIRE DISTRICT 'j SITE ADDRESS 1 \S 111AQ` V`'1-e,�,r, CITY DIRECTIONS TO SITE ADDRESS IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER❑ LAKE ❑ RIVER/CREEK ❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM❑ TYPE OF WORK: NEW ❑ ADDITION❑ ALTERATI\ONJ& REPAIR❑ OTHER ❑ USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) ''Ke5" IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS HEATED STRUCTURE? YES(Whole Bldg)( YES (Part(s]of Bldg) NO ❑ DESCRIBE WORK J�,A& L.cnof\Xlty. toOm - $S"Yvvo�\-q— SQUARE FOOTAGE: (propose+existing) .(4yioctd, 0 V a- 57617O 1 ST FLOOR sq. ft. 2ND FLOOR sq. ft. 3RD FLOOR 7sq. ft. BASEMENT sq.ft. DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHEk3l oQ;)- sq.ft. GARAGE sq. ft. Attachea I 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 ❑ SEWERX / NEW ❑ EXISTING ❑ PLUMBING IN STRUCTURE? YES NO ❑ Ifyes, attach completed Water Adequacy Form PERIMETERNOUNDATION DRAINS PROPOSED? YES ❑ NOX' EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS S TOTAL BEDROOMS 3 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 mull&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) 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 KECEIVED MASON COUNTY MAR 0 2 2018 COMMUNITY SERVICES BUILDING G15 W. I A} Building,Planning,Environmental Health,Community Health Alder Street Physical and Mailing Address 615 W Alder St.,Bldg 8, Shelton, WA 98584 Shelton Phone: (360)427-9670 ext 352 •3 Fax (360)427-7798 PLUMBING & MECHANICAL PERMIT APPLICATION Permit M-51GI ZU 18 '060165 OWNER INFORMATIONk CONTRACTOR INFORMATION: NAME: NAME: MAILING ADDRESS: 4 MAILING ADDRESS: CITY: STATE: ZIP: CITY: STATE: ZIP: 1st PHONE: PHONE: CELL: 2°d PHONE: EMAIL : EMAIL: L&I REG# EXP. PARCEL INFORMATION: 1 PARCEL NUMBER (12 Digit Number): (r� o �� n I D Zoning: LEGAL DESCRIPTION (Abbreviated): SITE ADDRESS: CITY: DIRECTIONS TO SITE ADDRESS: TYPE OF JOB/WORK: NEW ADD ALT REPAIR OTHER USE OF BUILDING PLUMBING FIXTURES MECHANICAL UNITS [] Electric in-wall heaters(no fee) Type of Fixture No. of Fixtures Fuel Type Fees Type of Unit No. of Units Fuel Type Fees Toilet(s) Furnace [E/G/LPG] Bathroom Sink(s) Heat Pump [E/G/LPG] Bath Tub(s) o Ductless H.P. [E/G/LPG] Shower(s) Spot Vent Fan Water Heater(s) [E/G/LPG] Propane Tank [ gal.] Clothes Washer(s) I [E/G/LPG] Gas Outlet(s) Kitchen Sink(s) Heat Stove [E/G/LPG/W] Dishwasher(s) c . YG.t.lti Kitchen Exhaust Hood Hose bib(s) Dryer Vent Other Solar Panel Other Other Plumbing Subtotal Mechanical Subtotal Plumbing Base Fee Mechanical Base Fee Final Inspection Fee Final Inspection Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER/BUILDER acknowledges 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,owners legal representative,or contractor.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 authorized agent 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 IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Signature of Applicant Date X Owner/Owners Representative/Contractor Print Name (Circle one) DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS O Building O Fire Marshal O Permit Tech (OTC permit only) Visit us on-line: http://www.co.mason.wa.Lis/comrnun;tv_dev/ Rev 3/08/2017