HomeMy WebLinkAboutBLD2023-01316 Retaining Wall - BLD Application - 10/30/2023 MASON COUNTY COMMUNITY SERVICES Permit No::D O 20A/ •611_�I L
PERMIT ASSISTANCE CENTER: RECEIVED
� .BUILDING•PLANNING.PUBUC HEALTH•FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584
(' Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone
Belfair(360)275-4467•Phone Elma:(360)482-5269 OCT 3 0 2023
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INF� A
t
NAME: ' V c f NAME:
MAIL Q ADDRESS: c �'rr' MAILING ADDRESS:
CITY: a 1 " STATE:w A. ZIP: CITY: STATE: ZIP:
PHONE#I: ' PHONE: CELL:
PHONE#2:_ EMAIL:
EMAIL: _1 T ) -, L&I RFG# EXP.
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER❑
NAME EMAIL
MAILINGADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) oC� I—o ZONING
LEGAL DESCRIPTION(Abbreviate FIRE DISTRI
SITE ADDRESS 2 Q 5 F 'IL 6VZel,
DIRECTIONS TO SITE ADDRESS v
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 ihorapply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ A RATION[] REPAIR❑' .1O�T,HpERp ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.f l�l C A�110 l/ WG(—i—
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUC ? YF�,S(Whole Bldg)❑ S(Parl(sJojBldg)❑ NO
DESCRIBE WORK L
SQUARE FOOTAG ': proposed)
I ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BA ft
DECK sq.ft COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Anac a etac re
73 MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQ D*
1 MAKE MODEL YEAR LENGTH
• H BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURC R❑ / NEW❑ EXISTING❑
PLUMBING RUCTURE? YES❑ NO❑ ach completed Water Adequacy Form
PERT TERTOUNDATION DRAINS PROPOSED? YES❑ NO❑
STING 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
101 COUNTY CODE 14.08.42)
X
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT J'2 /(��
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH