HomeMy WebLinkAboutBLD2021-01042 SFR - BLD Application - 7/6/2021 MASON COUNTY COMMUNITY SERVICES Per o: 31
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PERMIT ASSISTANCE CENTER: JQ ;
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584
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Phone Shegon:(360)427-9670 ext.352•Fax:(360)427-7798 Phone ���
Belfair.(360)275-4467•Phone Elms:(360)482-5269
0 6 2021
BUILDING PERMIT APPLICATION 5
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: vder Stre et
NAME: -I{ f*10ilti1 NAME: PA CO PPO 4it
MAILING A DRESS: 4W t S t 44 ?ot. MAILING ADDRESS: 4 - J
CITY: be 14®ti I' STATE: ZIP: CITY: 01sgrnp1&- STATE:UrW ZIP: T1�•
PHONE#I: PHONEY— CELL: 6 470 CISAI
PHONE#2: EMAIL: EV to i%C to Loa t. A-
EMAIL: wt+int fLp ja&rc ,IA. . *.&A— L&I REG# 2V1 a EXP. _LA
PRIMARY CONTACT: �,, OWNER❑ CONTRACTORS' OTHER❑
NAME Oi., Wrn�pn _ EMAIL
MAILING ADDRESS % 41, CITY STATE WA ZIP _
PHONE 366 4 CI CELL Ift N C ' R OG
PARCEL INFORMATION: OWL
PARCEL NUMBER(12 Digit Number) ZONING TF
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITEADDRESS 34rI0 � S -JC (taN{G 701- CITY "CITollr
DIRECTIONS TO SITE ADDRESS
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 that apply):
SALTWATER LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIRJJ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Ercf �0f
IS USE: PRIMARY' SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(whole Bldg)❑ YES(Pan(,)ufBidg)❑ NO❑
DESCRIBE WORK
SQUARE FOOTAGE:(proposed)
IST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.fL
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: 1,
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER Jf� / NEW❑ EXISTING Jk
PLUMBING IN STRUCTURE? YES❑ NO❑ _\ Ifyes,attach completed Water Adequacy Form
PERIMETERNOUNDATION 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 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 permittapplication 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
COUNTY CODE 14,08.42)
ignature of OWNER(Must be signed by the OWNER) T— Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDI[TTONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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