HomeMy WebLinkAboutBLD2018-00990 Replace Dock, Pier - BLD Application - 9/11/2018 �aozz�� r MASON COUNTY COMMUNITY SERVICES
A 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 ����2M%
Belfair.(360)275-4467•Phone Elma:(360)482-5269
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13 U I LD I N G BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: V V11t�,�,C
NAME: I��RR� �iaY,e. NAME: Ma� 5*efit��'' C611ti�" 'GL
MAILING ADDRESS: It W0 5 io Ka. waif Nw MAILING AD,D SS: /977
CITY: q,'k4e1d ale, STATE: WA ZIP- Q B 3 83 CITY: D✓L/�! STATE: Z
PHONE#1: -3bo a 1. — 3 30 8 PHON SELL:
PHONE#2: EMAIL : r.
EMAIL: 1 rr , ' . yKe 09 wte; • CoVA L&I REG# I)Ai Y V EXP. /; /
PRIMARY CONTACT: OWNER❑ CONTRACTORS O HER❑
NAME EMAIL a &Vl GQ
MAILING ADDRESS CITY STATE ZI
PHONE CELL G
PARCEL INFORMATION: /n�,,�l
PARCEL NUMBER(12 Digit Number) 113 O 5- 11 -9 0l 3 a. ZONING
LEGAL DESCRIPTION(Abbreviated)T R 3-B 0q GoVT I-OT I E)CTR a $P* MIE DIS CT
SITE ADDRESS SS- Z' Lt k2 1 ✓1 CITY t
DIRECTIONS TO SITE ADDRESS�%rnM f3el�r?., tave OkI 11604 nR 1�alley Roloh .tu y-rt 1e Ffior�toi.
u:aCto—�3earCrpe
fOdc�. 'hKe �ighton`r►aer MY ss;o1J lK sorb, ('aKe (e4olrt Mo��teh AaKe l�c.ye.., %vnmed;a.� le-P dorm stye�
�;� aoe {oTi •� ta►et.• se-ee- -tv tas pareet o- yeL'f le 1-..-
S THE PROJEC� 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 Y RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ OTHERS
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc. .0 - �° t
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BED OOMS NUMBEROF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg) ❑ YES(Part[s]of Bldg) ❑ NO❑ � �0
DESCRIBE WORK 0 CI-91eA I 1
SOUARE FOOTAGE: (propose+existing) UC7 1 t11I
Iry I ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMEN sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHERsq•ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED - DR�ATT *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
TH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/ SOURCE: SEPTI WE ❑ / NEW❑ EXISTING❑
PLU ING IN STRUCTURE? YES ❑ NO❑ es, attach completed Water Adequacy Form
P TER/FOUNDATION DRAINS PROPOSED? YES❑ EXISTING SQ.FT.
XISTING BEDROOMS PROPOSED BEDROOMS TOTAL B
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 permit/application becomes null 1£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)
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X Date
ignatu OWNER(Must be signed by the OWNER)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL .�
PUBLIC HEALTH n u Ci 6V I ,
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1�6.00 FR0f=ERT1' LINE
APPROVED
MASON COUNTY DCD PLANNING
SITE PLAN REQUIRED TO BE ON SITE
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