HomeMy WebLinkAboutBLD2019-00473 Deck - BLD Application - 5/8/2019 MASON COUNTY COMMUNITY SERVICES
PERMIT ASSISTANCE CENTER: Permit No:
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584
- Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone MAY 0 8 2019
Belfair.(360)275-4467•Phone Elma:(360)482-5269
1854
BUILDING PERMIT APPLICATION
615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: !cx 1-4✓d c� . 5K6 s NAME: (.J t (c t-- C'P!-tC'a1
MAILING AD SS: 130 l✓ f MAILING ADDRESS:
CITY: (( STATE: 00_ZIP: g SZ CITY: � STATE:GO- ZIP: �S`Z
PHONE#1: PHONE: '3 Ca--(.`fS 2r010ELL: f "
PHONE#2: EMAIL : 6-),'(((4 .f- d e,.�,e lcy,,,c,�-6 cp,, fCtK• c,N
EMAIL: L&I REG# (,J1 1-t f D PVZO,U t'UEX P 1J-1[5-/?-C)'
PRIMARY CONTACT: OWNER❑ CONTRACTOR& OTHER❑
NAME T'ySon ( ) �I ((qw.s' EMAIL (� ( It�•.`S C�eue(Go�^'. .t C-c
MAILING ADDRESS f�� ( 75--C; CITY pl- STATE ��'T ZIP �ii S-Zy
PHONE -366 - G-f5 - 2 5"1 CELL
PARCEL INFORMATION: BUILUM
PARCEL NUMBER(12 Digit Number) 1 -2- S 3 — 6 Po "-" C2 ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 130 - 1` " r 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 y ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etta
IS USE: PRIMARY ❑ SEASONAL ❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg) ❑ YES (Part[s)of Bldg) ElNO ❑
DESCRIBE WORK �� �( (2A c�
SQUARE FOOTAGE: (propose+existing)
IST FLOOR sq.ft. 2ND FLOOR sq. ft. 3RD FLOOR sq. ft. BASEMENT sq. It.
DECK 1 )C/__ _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 MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC ❑ SEWER❑ / NEW ❑ EXISTING ❑
PLUMBING IN STRUCTURE? YES ❑ NO ❑ If yes, 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 1 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 permittapplication 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
O NTY CODE 14.08.42)
XrER
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Signature of e OWNER) Date
DEPARTMENTAL REVIEW APPROVED DAT DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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156.56`
PLANNING:
ALL SETBACKS ARE MEASURED
FROM tME FURTNESY G I T� PLAN
PROJECTION OF THE BUILDING J I A 51TE ADDR -56
I = 201-01I 130 E HOFAKER RD
ALL.YN, WA a8524
PARCEL NUMBER
THIS SITE PLAN 15 DRAWN BASED ON
DATA SUPPLIED BY CLIENT AND WITHOUT 12217-55-00040
BENEFIT OF SURVEY OR TOPOGRAPHY