HomeMy WebLinkAboutBLD2019-00961 Deck - BLD Application - 8/28/2019 cot; MASON COUNTY COMMUNITY SERVICES •�V ) �`"`_ ���] ,,u�
^� PERMIT ASSISTANCE CENTER: Permit No: C7 C7��o o
' .BUILDING.PLANNING •PUBLIC HEALTH•FIRE MARSHAL _
615 W.Alder Street,Shelton,WA 98584 RECEIVED
Phone Shelton:(360)427-9670 ext. 352•Fax:(360)427-7 F,hor1
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Belfair:(360)275-4467•Phone Elma:(360 I�,,V AUG 2 g 2019
St y To sue• ��Z BUILDING PERMIT APPLICATION 615 W. A der Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAMEP,f4use lP65m-po-p -:S NAME: "eI n
MAILING ADDRESS:Z&Q0 &14A4?-QAaCS0N(,A*A MAILING ADDRESS:
CITY: Ki NGagTpi\� STATE:_ZIP: 34 CITY: STATE: ZIP:
PHONE#1: Zoe 3601 36116 PHONE: CELL:
PHONE#2: EMAIL :
EMAIL: CF�Q(�� FOLjp •(��y� L&I REG# EXP.
PRIMARY CONTACT: I OWNER CONTRACTOR❑ OTHER❑
NAME s/he" _t2/-) Gtlgnze EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:PARCEL NUMBER(12 Digit Number) 1 ZZZ0— ,�--0000( j ZONING 1!�
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LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS_ 141 f ASr OLD ROAD CITY ,14(.,1.'lIJ
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 thatapply):
SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑
TYPE OF WORK: NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ OTHER ❑
USE OF STRUCTURE (Residence, Garage, Commercial Bldg,Etc. EC�
1S USE: PRIMARY ❑ SEASONAL [ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole (Bldg) ❑ YES
(P rt[sJofBldg) ❑ NO
DESCRIBE WORK17�o►CR rbtte�� oC l � 11QUJ C1eGk
SQUARE FOOTAGE: (propose+existing)
1ST FLOOR sq. ft. 2ND FLOOR sq. ft. 3RD FLOOR sq. ft. BASEMENT sq. ft.
DECK 20 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 k [f yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NO® EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS s�
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
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
UNTY CODE 14.08.42)
X 28 2C)1
Signatur o O Must si by the OW R Date
DEPART ENTAi EV4 APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
_ � p PIANNIN
t75�,-es -2-w t n
R�CEs�E
AUG 18 2019
615 W ,cu
der Strut
APPROVED
MASON COUNTY DCD PLANNING
SITE PLAN REQUIRED TO BE ON SITE
CHANGES SUBJECT TO APPRO A
0 /
Date cJ