HomeMy WebLinkAboutBLD2024-00733 Repairs - BLD Application - 6/17/2024 Permit No: ��
MASON COUNTY
COMMUNITY DEVELOPMENT
C Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: CRISTOBAL FAMILY TRUST NAME:ERICKSON CONSTRUCTION
MAILING ADDRES 42ND AVE SW MAIIdNG ADDRESS:
CITY:FEDERAL WAYSTATE: ZIP: 88023 CITY;GIG HARBOR STATE: vvtk ZIP:
PHONE#I: PHONE:253-906-3120 CELL:
PHONE#2: EMAIL: ren eric kson-constru ion.Com
EMAIL: L&I REG#ERICKC*809LJ EXP. 07/26724
PRIMARY CONTACT: OWNER❑ CONTRACTORX OTHER❑
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 32127-54-00013 ZONING RR5
LEGAL DESCRIPTION(Abbreviated) LAKE LIMERICK 5 TR 13 FIRE DISTRICT 5
SITE ADDRESS 280 E CLONAKILTY DR CITY SHELTON
DIRECTIONS TO SITE ADDRESS East Mason Lake Rd, right on E Clonakilty to property at end of rd.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO X SNOW LOAD:_psf
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❑ REPAIRR OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) Sfr
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)$ YES(Parr(s)ojBldg/❑ NO❑
DESCRIBE WORK replacing 4 trusses,roof and sheetrock in damaged areas from tree damage Value of work 40K
SQUARE FOOTAGE:(proposed)
1ST FLOOR sq.ft. 2ND FLOOR sq.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 YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTICR SEWER❑ / NEW❑ EXISTINGX
PLUMBING IN STRUCTURE? YES X NO❑ Ifyes,attach completed Water Adequacy Form
PERIMETERNOUNDATION DRAINS PROPOSED? YES❑ NOX 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 8 void if work or authorized construction is not commenced within 180
days or it 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 /If egg t', AW�n, Agent 6/6/24
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT *J►` &471tk
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH