HomeMy WebLinkAboutCOM2021-00079 Cancelled Bridge Replacement - COM Application - 9/13/2021 MASON COUNTY COMMUNITY SIERVICES Permit No:
PERMIT ASSISTANCE CENTER: RE IV E D
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
GO 615 W.Alder Street,Shelton,WA 98584
Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone SEP 13 2021
BeHair.(360)275-4467•Phone Elma:(360)482-5269
BUILDING PERMIT APPLICATION 615 W. Alder Street
PRO RTY OWNER INFORMATION: CONTRACTOR INFORMATION:
E; SakL+h L NAME:14"S41/1 [r X Ca 1JiL' A
ING ADDRESS: 13-: 2-40, MAILING ADDRESS: B& Sc 134+11_ I-n_
Y:(A h 1 0✓� STATE: W w ZIP: d1 5A L CIT h ( v STATE:%,�A ZIP: C�k5
PHONE#1: �j(pO— '�QPi— ?j99 Go- ELL:
PHONE#2: 1
EMAIL:��
PRIMARY CONTACT: OWNER® C T OR❑ OTHER❑
NAME GGhf I EMAIL C1LKb Q h��Car1r►,I•rlelr
MAILING ADDRESS CITY t1V%L4.jh STATE S y M. ZIP!I k,Z-
PHONE CELL
PARCEL INFORMATION: �+
PARCEL NUMBER(12 Digit Number) '�Z. 1 DJ 1 3 ZONING
LEGAL DESCRIPTION(Abbreviated) t 3� FIRE DISTRICT
SITE ADDRESS $C CITY UY1 l
DIRECTIONS TO SITE ADDx F�SS ✓ Sh&1 4Ke C d►vt
v►vr� l C>1 C- I SI-C,14
IS THE PROJECT WITHIN)kOo OF SLOPE(S)GREATER THAN 14%: YES[] _NO N SNOW LOAD: psf
IS PROPERTY WITHIN 200 F F THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ R/CREEK9 POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
fSEOFSTR
WORK: ❑ ADDITION❑ ALTERATIONN❑ REPAIR❑ OTHER ❑
CTURE nce,Gaage,Commercial Btdg,Etc.) 1r1P SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
S U (? YES(Whole Bldg)❑ YES(Partlsl gfBidg)❑ NO❑
D RIBEWO RG�14le. -�i�tn5 yod'icjc-
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: SEPTIC❑ SEWER❑ / NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES❑ NO❑ Ijyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION 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.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&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
PER T APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X / ✓ 7 2-
signature of OWNER(Must be signed by the OWNER Drate
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
• gQft ♦ •
ARCTOS
I
• % % ;% pp'I AERIAL
Environmental Consulting I Drone Imagery
PO Box 2466
•. 1 ; ; Shelton, WA 98584
• (425) 344-9315
arctosaerial@gmail.com
$ www.arctosaerial.com
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Existing,•
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Map created by: Rob Nagel
••- May 29th, 2021
nd Greek Revison:
e
•
Bge
: ;' •.
•, Existing Bridge/
�o N
•♦ ...... �'•• � Replacement Location
t 611 ft ' ' 0 40 80 120 160 ft
EQA MY,-RD
Scale: 1 " = 60'
. •
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