HomeMy WebLinkAboutCOM2024-00017 phase 2 repairs fire damage - COM Application - 8/27/2024 . -
MASON COUNTY COMMUNITY SERVICES Permit No:(_*!;'i l� 2 c�Z.l �Qa I �"
PERMIT ASSISTANCE CENTER:
•BUILDING•PLANNING-PUBLIC HEAL7H•FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98594
Phone Shelton:(360)427-9670 ext 352•Fati(360)427-7798 Phonean
Belfair.(360)275-4467•Phone Elme:(360)482-5269 l�X +��'V 'ee
BUILDING PERMIT APPLICATIONPh
_ 7 -202�
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME - 111h :
MAILING DRESS: MAILING ADDRESS:
CITY: STATE: ZIP: CITY: STATE: ZIP:
PHONE#1: PHONE: CELL:
PHONE#2: EMAIL:
EMAIL: L&I REG# EXP.
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER❑
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
p,) PARCELNUMBER(12 Digit Number) o�-�(� i 1('tllli� ZONING
LEGAL DESCRIPTI Abbre�atei FIRE DISTRICT
SITE ADDRESS
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPES)GREATER THAN 14%: YES[] NO❑ SNOW LOAD:_psf
IS PROPERTY WTrHIN 200 FT OF THE FOLLOWING: (Ch—k all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER El
' USE OF STRUCTURE(Residence,Garag4 Cammerdal Bldg.Etc)
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
(� HEATED STRUCTURE?. S(Whole Bldg) YE (Part[s]of$]dg)❑ N ❑ . l
V DESCRIBE WORK t' ( "1 UIC t! ' I tC
w SQUARE FOOTAGE:(propared)
1ST FLOOR sq.& 2ND FLOOR sq.it 3RD FLOOR sq.ft. BASEMENT sq.fL
l DECK sq.fL COVERED DECK sq.& STORAGE sq.fL OTHER sq.fL
GARAGE sq.fL Attached❑ Detached❑ CARPORT sq.&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•Adeguacy Form
PERMfETERTOUNDATTON DRAINS PROPOSED? YES❑ NO❑ EXISTING SQ.FP.
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 1 am entitled to receive this permit and to do the work as proposed.I have _
obtained permission from all the necessary parses,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 acces to the above described property
and structure(s)for review and inspection.This pemnftlappfication becomes null 8 void If work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 190 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
DEPARTIYII:NTAL RLVJEW=-_' APPROVED: DATE`= _DE1V'�D DATE '.TAGS/NOTES/CONDITIONS '
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH