HomeMy WebLinkAboutBLD2019-00996 Cancelled Adding Garage Door - BLD Application - 9/9/2019 ',i+a ao1G •��1�MASON COUNTY COMMUNITY SERVICES Permit No:
PERMIT ASSISTANCE CENTER-
-BUILDING •PLANNING •PUBLIC HEALTH-FIRE M SH
615 W.Alder Street,Shelton,yVg�5 4(LO ING
Phone Shelton:(360)427-9670 ext. 352•Fax:(327-7798 Phone AUGBelfair. (360)275-4467•Phone Elma:(360)482-5269 G 12 2019
BUILDING PERMIT APPLICATION
615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: A am NAME: �5L
MAILING ADDRESS: MAILING ADDRESS:
CITY: STATE:W ZIP: CITY: STATE: ZIP:
PHONE#1: I PHONE: CELL:
PHONE#2: EMAIL :
EMAIL: L&I REG# EXP.
PRIMARY CONTACT: I - OWNER CONTRACTOR❑ OTHER❑
NAME L JYY M YI't'L�v EMAIL
MAILING ADDRESS �'64 M CITY STATE ZIP
PHONE SOL an CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 2 50,5 6_0 002). ZONING
LEGAL DESCRIPTION(Abbreviated) k FIRE DIST CZ
SITE ADDRESS CIT r
DI>ZECTIONS TO SITE ADDRESS
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IS T E PROJECT WITHIN 300 FT F SLOPE(S)GREATER THAN 14%: YES[] NOI�
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER ❑ LAKEK RIVER/CREEK ❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑
TYPE OF WORK: NEW ❑ ADDITION ❑ ALTERATION REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc. &a4
IS USE: PRIMARY SEASONAL ❑ NUMBER OF BEDROO NUMBER OF BATHROOMS
HEATED STRUCTU ? YES (Whole Bld ❑ YES (Part[s]of Bldg) n NOV
DESCRIBE WORK � E ,Vl
SQUARE FOOTAGE: (proposed) &J)(k11 Ir✓
I ST FLOOR sq. ft. 2ND FLOOR sq. ft. rRD FLOOR sq. ft. BASEMENT sq. ft.
DECK 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 ❑ Ifyes, attach completed Water Adequacy Form
PERIMETER&OUNDATION 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 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 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
COUNTY CODE 14.08.42)
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S u e f WNE ust be si ned b the OWNER Date
DEPARTMENTAL REVI W APPROVED DATE DENIED D#Ty TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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gis W. Alder Street
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Direction: Scale: Approval: for office use
LOOwner/Applicant:
g Permit number: _ Building:
Date of Planning:
application: Env. Health:
Number:
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