HomeMy WebLinkAboutCOM2024-00085 Repair Dock - COM Application - 10/30/2024 -4A—
Docusign Envelope ID:E9401DB8-3818-4935-8411-3345421999AE
Am M7- MASON COUNTY Permit No: a D
COMMUNITY DEVELOPMENT
Permit Assistance Center, Building,Planning OCT 3 0 2024
BUILDING PERMIT APPLICATION 815 r Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Taylor Jacobs(STOA 3 HOODSPORT LLC) NAME:Integrated NW Construction,LLC(Project Manager.Sarah Kupers)
MAILING ADDRESS:25381 N US Highway 101 MAILING ADDRESS:PO Box 1008
CITY:Hoodsport STATE:WA ZIP:98548 CITY:Hoodsport STATE:WA ZIP:96548-1008
PHONE#1:9494504748 PHONE:253-888-5314 CELL: 360-968-3"1
PHONE#2: EMAIL:psa@integratedNWconstrucnon.com
EMAIL:Taylor@stoalodging.com L&I REG#INTEGNC843J1 ExP. 04/21/26
PRIMARY CONTACT: OWNER[I CONTRACTOR E] OTHER❑
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 422014300010 ZONING R5
LEGAL DESCRIPTION(Abbreviated) PCL 1 OF BLA#00-42 a TAX 844A S 46/204 FIRE DISTRICT
SITE ADDRESS 25381 N US Highway 101 CITY Hoodsport
DIRECTIONS TO SITE ADDRESS From Shelton take US 101-N,drive 13.4 miles then turn left onto 25381 US-101(Glen Ayr Resort).
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO❑+ SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑] OTHER ❑
USE OF STRUCTURE(Residence.Garage,Coeunemal Bldg,Etc.)Commercial Dock
IS USE: PRIMARY❑� SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(part[s ,fBldg)❑ NO❑
DESCRIBE WORK Repairs to existing floating dock,no expansion of the footprint
SOUARE FOOTAGE:(pmp a)
1 ST 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: SEPTIC 0 SEWER❑ / NEW❑ EXISTING❑+
PLUMBING IN STRUCTURE? YES[I NO Ijyes,attach completed Water Adequacy Form
PERIMETERNOUNDATION DRAINS PROPOSED? YES❑ NOE] EXISTING SQ.Fr.
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 permiUapplication 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
s b r. COUNTY CODE 14.08.42)�� .X " , , k
10/29/2024
Signature
of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
Glen Ayr: Existing Pier, Ramp, and Floating Dock System
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