HomeMy WebLinkAboutBLD2022-01161 ATF Bulkhead, New Pier Dock - BLD Application - 8/31/2022 MASON COUNTY COMMU9N11Y SERVICES Permit No:
PERMIT ASSISTANCE CENTER:
�„ •BUILDING o PLANNING o PUBLIC HEALTH o FIRE MARSHAL
615 W.Alder Street,Shelton,WA SS584
Phone Sheton:(360)427-9670 ext.352 o Fax:(360)427-7798 Phone
r. Betlelr:(360)275-4467-Phone Elma:(360)462-5269
BUILDING PERMIT APPLICATION AUG ,?
PROPERTY OWNER INFORMATION:` CONTRACTOR INFORMATION: 5 I/
ISAME: 'uVa G� RO�th JOhhS� -NAME: LCLV6hay-e-0- nS &6-Idn
MAILING RES5:f I at M1 AILINGADDRESS:�SW WE 14tN+Y►5 HOYB
CITY: a h V�yet,• ' STATE:'W CITY: �el�i✓ STATE: ZIP: $
PHONE#1: <j Z5 Lj PHONE: LL:
PHONE#2: _ —_——_ EMAIL: P42-aLd . a t 0
EMAIL: YO b!n t 0 n Ova (�InDO�GG»^ L&I REG#_LjAK85 Gk t 55)A EXP. 'jl 29/ 23
I O NER❑ CONTRACTOR[] OTHER
NAME EMAIL 97 n
MAILING ADDRESS CITY �I TATE ZIP 1i
�
PHONE CELL Lr�Q? _
PARCEL INFORMATION: A
1jL
PARCEL NUMBER(12 Digit Number) 2Z 330 . So •p 3 - ZONING NG
LEGAL DESCRIPTION(Abbreviated) �/EN L�kl�� TR. ►`5?� h S�FIRE DISTRICT
SITE ADDRESS rjAWl—Pi G��l/JUV Ci CITY _
DIRECTIONS,TO SITE ADDRESS W A 6E -L-a de l►—• -A (-e 06 W 3co. TZ,
TJ E i'se( i v Ton kV_ f N Ems} v i1 as UV OL <
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN YES Q NO R] W 2 15 on
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER Q L.AKEg RIVER)CREEK Q POND[] WETLAND Q SF,ASONALRUNOFF❑ STREAM❑
TYPE OF WORK:I W ADT?TTION D ALTERATION❑ REPAIR❑ OTHER ❑
D � r
USE OF STRUCTURE(Residence,Garage,Commercmt Bldg,Etc.)_
IS USE: PRIMARY❑ SEASONAL.Q NUMBER OF BEDROOMS ___ NUMBER OF BATHROO _
IDEATED STRUCTURE? YES(WltoleBrdg)Q YES(Parr(sl ofBrdg)❑ NO Q' �,{^rl'�t AT
DESCRIBE WORK i(/11h �I YTP.iAJ, t7t�l_>�f 1__ r e✓ �1t2(
SQUARE FOOTAGE:(propose+existing) Z�1�J `��' pt G✓^
1ST FLOOR --sq.ft. 2ND FLOOR -_sq.ft. 3RD FLOOR_^__sq.R. BASEMENT sq.R
DECK sq.ft. COVERED DECK___sq.ft, STORAGE_ sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached Q CARPORT—._ sq.8. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL---�_ � YEAR.,----,--LENGTH
WIDTH BEDROOMS _,r_ BATHS -SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC SEWER❑ 1 NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES❑ NO R- If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES[] NOS 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 fuither declare that I am entitled to receive this permit and to do the work as proposed I have
obtained permission from all the necessary patties,including any easement holder or parties of interest regarding this protect The owner ar 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 permfflapplication becomes null 8 void if mrkor authorized construction is not commented 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 o�� - g. 30•1 y
Signature of OWNER(Must be slaned bv_the OWNER I Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSlNOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT G
FIRE MARSHAL