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HomeMy WebLinkAboutCOM2020-00011 Replace Covered Entry - COM Application - 8/22/2000 MASON COUNTY COMMUNITY SERVICES Permit No: PERMIT ASSISTANCE CENTER: •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL 615 W.Alder Street,Shelton,WA 98584 RECEIVED Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone Belfafr.(360)275-4467•Phone Elms:(360)482-5269 JA N • BUILDING PERMIT APPLICATIONRic 1Ao 2 ? �Q20 PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: e Street NAME: I t7 NAME: W -- RES : - - - CITY: STATE: ZIP: CITY: S ATE: ZIP: PHO #1: PHONE: - 10ELL: PHONE#2: EMAII : i D EMAIL: L&I REG EXP. PRIMARY CONTACT: OWNER CONTRAC[OR)4 OTHER❑NAME EMAIL 1tK/t%t�n.jlJU I I VS P/1 ,C p)7--- MAILING ADDRESS !Z411.o NW ' ,,. STATE W A ZIP PHONE CELL PARCEL INFORMATION: rr PARCEL NUMBER(12 Digit Number) ,I �'�32 5(7 t•,r�17 ZONING �Tr?il Y UG7 Pr LEGAL DESCRIPTION(Abbreviated) FIRE DIS CT SITE ADDREss-23061 Njj& 12V 3 CITY DIRECTIONS TO SITE ADDRESS }1' 1 3 IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check as drat applv): SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEW❑ ADDITION I4 ALTERATION❑ REPAIR❑ OTHER ❑ ' USE OF STRUCTURE(Residence,Gamge,Commercial Bldg,Etc.) C k1AYck' IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS O' HEATED STRUCTURE? YES(whole Bldg)❑ YES(Part[,)of Bldg) NO❑ It DESCRIBE WORK O SOUARE FOOTAGE: (propose+existing) Door rtrp o f i 2 P /z e 1ST FLOOR sq.ft 2ND FLOOR sq.ft. 3RD FLOOR sq.R BASEMENT sq.ft DECK sq.R COVERED DECK I C1 Z sq.R 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❑ Ijyes,attach completed Water Adequacy Form PERIMETERNOUNDATION 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.1 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 permittapplication 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 180 days. 1 PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS -- —PER-MIT APPLICATION-OF-480-DAYS-OF MORE WILL CAUSE-THE-APPLICATION ---- - - ---- COUNTY CODE 14.08.42) X ' Signature of OWNER(Must be signed by the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT d FIRE MARSHAL PUBLIC HEALTH Mail-Joseph Builders NW Ilc-Outlook '- APPROVE® f �' MP SON COUNTY IBDC© PLANNING P LAN N I N G• SR'E PLAN REQUIRED TO BE ON SITE ALL SE BACKS ARE MEASURED CHAN ES S ET TO APPROVAL > � FROM THE FURTHEST By A s FRO�ECTION OF THE BUILDING D Z W N � f LA CL a f F _ I i a Q s0 O ' f ti N s }� zC �� \ 10 a' C .� i r <„ ; 1 https://outlook.l ive.com/maii/0%i nboxriid/AQMI<ADAwATMwMAItYjgxYIOXZJZJLTAWAiOwMAoARgAAA6YfHFOTf3ZMtV7%2Bx8cAsFunBwA3MIM53purQo4x2CdTwxTiAAACAQwAAAA3M I M53purQo4x2C d... 1/1 V r.