HomeMy WebLinkAboutBLD2022-01437 Addition - BLD Application - 2/8/2023 MASON COUNTY COMMUNITY SERVICES Permit No: IDI Z 2Z -
PERMIT ASSISTANCE CENTER:
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584
Phone Shelton:(360)427-9670 exi 352•Fax(360)427-7798 Phone
Bellair.(360)275-4467•Phone Elmer(360)482-5269
co BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: M 1�� 2}'SL'►� NAME: O J,:.:1 a Y"
MAILING ADDRESS: W V C R C F -VZ MAZJ NG ADDRESS:
CITY: A!t I t,, STATE: W ZIP:L'S' r I-If CITY- STATE: ZIP:
PHONE#1: 3%X `,6- r'>r � PHONE: MT
PHONE#2: EMAIL:
EMAIL: ,► .'r-::r1(tc.r:c�. yrt hcc Ccr11 L&I REG# EXP. /
PRIMARY CONTACT: OWNERX CONTRACTOR❑ OTHER p w�
NAME 'a` EMAIL
MAILINGADDRESS CITY STATE ZIP
PHONE CELL M
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) ?C L21 - "i O'L ZONING
LEGAL DESCRIPTION(Abbreviated)L- .-% FIRE DISTRICT h
SITE ADDRESS t-4o i� H&rC( K o r- n ,j.f/L C1TY �I l N l l
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO❑ SNOW LOAD:_psf
IS PP.OPERTY WITHIN 200 FT OF THE FOLLOWING: pi ka a rapply):
SALTWATER.❑ LASE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION)< REPAIR❑ OTHER ❑
USE OF STRUCTURE(Bedda Garag4 Commercial Bldg.Ere)
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(WholeBidg)❑ YES(PartfrJofBldg)❑ , NO❑
DESCRIBE WORK , l C ,
SQUARE FOOTAGE:.d,rvpaeed) evul/)I/L 2"C
ISTFLOOR_LEL.1q.fL 2ND FLOOR sq.& 3RD FLOOR sq.fL BASEMENT sq.fL
DECK sq.fL COVERED DECK sq.fL STORAGE sq.flL OTHER sq.&
GARAGE sq.ft.Attached❑ Ddached❑ CARPORT sq.R Affached❑ Detached p
MANUFACTURED WAIEJNF ORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED-
MODEL YEAR LENGTH__
W DfDTTH BEDROOMS BATHS SERIALNUM$ER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER) / NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES❑ NO�( Ifyes,attach completed WaterAdeguacy Form
PERD EI UFOUNDATION DRAINS PROPOSED? YES❑ hNO� EXISTING SQ.FT.
EXISTING BEDROOMS _ PROPOSED BEDROOMS V TOTAL BEDROOMS
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Adawvdedgement 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 pr*cL 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 pennll1application becomes null✓S void If work or authorised construction is not commanced 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
PER APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08A2)
Signature of OWNER(Must be signed bythe OWNER) Date
DEp e,RTMET*1AL REVIEW=." ;APPROVED':'= DATES :'=_DENIED DATE"TAGSINOTES/CONDITIONS '
BUILDINGDEPARTIZINI J rt— -
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH