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AMC MASON COUNTY COMMUNITY SERVICES Permit No:?21 /I 7 Ut.4•(��f!c1 bb
PERMIT ASSISTANCE CENTER:
-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
Belfair.�(360)275-4467•Phone Elma:(360)482-5269 BUILDING
BUILDING PERMIT APPLICATION �
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: Amy Law NAME:_Allstar Windows
MAILING ADDRESS:530 N Lake Surf Dr MAILING ADDRESS:—PO Box 5063
CITY:Lilliwaup STATE: WA ZIP: 98555 CITY: Lacey STATE: WA ZIP: 98509
PHONE#1: 206-227-6349 PHONE: 360-789-3908 CELL: NA
PHONE#2: EMAIL : office@allstarwindows.net
EMAIL: amy.m.law(i,gmail.com L&I REG#ALLSTA*910 OB EXP. 9 /6 /25
PRIMARY CONTACT: OWNER❑ CONTRACTOR® OTHER❑
NAME Paul Kraus (all other infor same as above) EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION: SAME AS PROPERTY OWNER INFORMATION
PARCEL NUMBER(12 Digit Number) —2)9%_30C1 — " ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS ,5 _ � r CITY
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 that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑
TYPE OF WORK: NEW ❑ ADDITION ❑ ALTERATION X REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) Residence Window changed to SGD SEE ATTACHED
IS USE: PRIMARY X SEASONAL ❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES (Whole Bldg)X YES(Part[s]of Bldg) ❑ NO ❑
DESCRIBE WORK
SQUARE FOOTAGE: (propose+existing) N/A
1ST FLOOR sq. ft. 2ND FLOOR yq.ft. 3RD 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 N/A YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: N/A
SEWAGE/SEWER SOURCE: SEPTIC ❑ SEWER ❑ / NEW ❑ EXISTING ❑
PLUMBING IN STRUCTURE? YES ❑ NO ❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION 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 OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
COUNTY CODE 14.08.42)