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Home My WebLink AboutBLD2019-01064 Replace 3 Floats - BLD Application - 8/19/2019 �6�MASON COUNTY COMMUNITY SERVICES Permit No: O l.Q PERMIT ASSISTANCE CENTER:7 TAGS •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL 2rjC 615 W.Alder Street,Shelton,WA Phone � D R�Phone Shelton:(360)0)427-9670 ext.352•Fax:(360)4 I N G ( -ei v Bedair.(380)2754467•Phone Elma:(360)482-5269O BUILDING PERMIT APPLICATION AUG PROPERTY OWNER hN�F/ORM`ATION: CONTRACTOR INF/ORM/ATI01$15 NAME:�p i'f'1 �.t.C�!elr YL✓�� NAME: �r I A�/�G YLU�7� �*r frg@ MAILING ADDRESS: /6D/5� /9,64A/-�Il� MAILING ADDRESS: / DST je- -- ]]-9T t CITY: "h STATE: ItAt ZIP:915,0//!/ CITY: STATE: P ZIP PHONE#I: PHONE: 3•►(41�: PHONE#2: EMAIL: -1� la /Y1,Ri2/lUL , C,Gi Y1 CDIU L&I REG# EXP. PRIMARY CONTACT: OWNER❑ CONTRACTOR OTHER❑ NAME EMAIL MAILING ADDRESS /9-d RAT 17 %, CITY T{�' �l- STATE 614�),_ZIP?�--- PHONE 95' — :3:93 De�1__ CELL_�f�� PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) �7 U I /Q ZONING� ��— LEGAL DESCRIPTION(Abbreviated) FIRE DISTRI�C�`T� SITE ADDRESS 'e- C7Z i, (J��-r-R CITY /ULLIJv DIRECTIONS TO SITE ADDRESS S i= F lnk--t-�A L`fl�'N IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all rhw apph): SALTWATER A LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR)< OTHER ❑ USE OF STRUCTURE(Residence.Garage,Commercial Bldg,Etc. /� IS USE: PRIMARY❑ (I SEASONALA NUMBER OF BEDROOMS / NUMBER OF BATHROOMS HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Parl[s)ojBldg)❑ NOX DESCRIBE WORK /�iLl/VC FOOTAGE: (proposed) 1 ST FLOOR ND FLOOR sq.ft. 3 sq.ft. BASEMENT sq.ft. DECK sq.ft. COVERE STORAGE sq.ft. OTHER sq.ft. GARAGE q. . Attached❑ Detached❑ C Detached❑ MANUF� INFORMATION: *4 COPIES OF THE REQUIRED* MAKE MO D LENGTH WIDTH OOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: f;� SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER❑ / NEW❑ EXISTING❑ PLUMBING IN STRUCTURE? YES❑ NO❑ Ijyes,attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO)K 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 permit/application becomes null&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) X Signature of OWNER(Must be signed by the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH -1 MASON COUIM CDWKTI n y SERYTCPS Ppt W ASWTAW.E CENTEpt .•dtF.:1rM6•RAMM+C.sL.Acr'•tT_{;��..r+ZF;tsas.�x t,,,� IMS w Adw Dann.93jftm � a x rra� 't lyarr�-.'114�tF il�i'ns%,7<tir�aetsa:.•_�'+,.aAw `r BUILDING PERMIT APPLICATION � ---- _ r rRortm oa ER .r ��a-rR�rTOIT t rc�R��Tto : S,tr F •�- -� is ANM f EVE#. -s ZIP 1! GT Y T STATE. micKE n 74M LAI RaG s - EXP. Ir' awes: tIfIO�C NAME tQ AaL j l �f _ - CEL 1 �---- -- —fir { �'f AREEL WE92M TION: - i tA>ctZ?dL*l�Elt iu is+we6c:) !3 -v0_9 I l 90 u�+ � yrt`At LEGAL L scacrncN tw .,,.,q + Fe VaT>Ril TT i SrrEADMM W Tat PROJitCT WnlW 300}T OF SiOMM GRtAT%R TT1 LN 14%: YEW, vo f su rwA ;� L xT: c po..D a rT.+ - sf-ksc*u.Rangy__p STXL M O # TYPE OF WOR1C kEw` AMMON, ALT ATM-t, WAIXK Or m USE OF STRUCTURE ir-w, 1 LS LW P M41Y E; S&AX0kAL Jq 3:.14M OF REDROONtS CO, + � i I�A?E*�STL C7t'B£ YES isa+ [ 2 FS{3Aet+i I �' v0)K rESCRME i ST Fi00R ' R_002 d- 3 rq t iAii1 ►T------- D_ 1 DECJi oG R COS STMAGE t OTM__ jt4N' NTOR LAT7 %: •d C061A 4 OF IItQ!Ii<LD• NLA E k".DTH CaQiKS 6ATHS WALLL\'iI(M j ENV'IRONNWNTALHL4tTTJ I -- i '. S£Vr'AGFISE�`EIt SO:'RCE_ 5�7TC Q '.IET►'SR[' ti£�i a E.\I3iSiN�, � P:Awmr,nV sntK- yr YES Q NO Q T{+LT r" x:x+► waw-4&ip.nry Foam POUKEITAMMATION Dum PItomsE t YLS No)K E.IL'n"SQ rT EXlS14G BEDROOM RtOIOSED BEDROOMS c ALB DROOW go .a root#a0r er On+�vt waewx Amv a"0.".O.ar:arcre ow w he awm&V r Lfr- lcare ra I rr iy�rK du�r a vwi UP aaku�ae pw,,n oe!wn s1 to vmcr o perMe.rck*j"aere+a"kfdrr v w%m d r*nd mP d "Ogea lllw v~ar Wft ! noreerMso.R nioawrrr 7+t Cae t�'rarror➢re.a�51d a��!ro Tars ar�sowe d mY :A"mom It ry Mau*oGW.,Abw mmr7 r+i raur at s;for m rc cYpei7eaa errriv�aictaa+ re ►J a tod r+ro&if arrv*yr amoUs rr It"co=qr rw o: S: orsn!cwrncex'�arty aw+oad'K'dryt PROOF OF CONTINUATION F MY!}aI(ON PEAWT IcomS BY DEANS OF IVSAE T10N. INtACTMTY OF TsloS PERMIT C OI�!so . YS OF WILL CAUSE THE AFPLlCA TO BE (!ta►>siNt ttwo f DETAAnm%TAL ItEMW Af O%TD DA, Y l DP_%= DA TAG&%gT&&co no%,* QtJILDQ"DCs DEPAATULN, l *LBLIUHEALTN _._ _._. .�..