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HomeMy WebLinkAboutCOM2024-00077 thru 00082 I-503 6 Buildings - COM Application - 10/15/2024 MASON COUNTY COMMUNITY SERVICES Permit No: Loa) PERMIT ASSISTANCE CENTER: -BUILDING•PLANNING•PUMC HEALTH I FIRE N,ARSHAL 615 W.Alder Street,Shelton,WA93584 Phone Shelton:(360)427-9570 ext 352•Far(360)427-7798 Phone 8etfair:(360)2754467•Phone E/ma:(360)482-5269 � ) BUILDING PERMIT APPLICATION / PROPERTY OWNER INFORMATION: ,,/Q CONTRACTOR INFORMATION: RECEIVED k/1 NAME: 5i \I hl y v NAME: MAILING ADDRESS: /!.n mod__ MAILING ADDRESS: 0 C T 15 2024 CPTY:5A44*At STATE-bj* 7TP- CITY: STATE: ZIP: PHONE#I: � bv�7R4�sy PHONE: CEff- PHONE##2: EMAIL 15 W. Alder Stree EMAIL: & *11 L&I REG# PRIMARY CONTA OWMR K CONTRACTOR❑ OTHER P JHS NAME EMA IL G r MAILINGADDRESS 1AA1 CITY STATES ZIP PHONE 2160--M CELL PARCEL INFORMATION: 1 PARCEL NUMBER(12 Digit Number)YZeda- -ag—groaj� . ZONING JZA&11S'I`'�'l j'"' LEGAL DESCRIPTION Abbreviated) .Sµ b ph/[ �G.*7 FIRE DISTRICT CeUf-Pee I" a� r SITE ADDRESS NJ. w4 c,7 CITY ke— /I Amc� DIRECTION TO SITE ADDRESS a� /40 TO W D O w���1d �T IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 141: YES[] IdO� SNOW LOAD:_psf IS PROPERTY WITHIN 200 FP OF THE FOLLOWING: (Checker char apply): J, SALTWATER❑ LAKE[] RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF ElSTREAM❑/�" TYPE OF WORK: NEWX ADDITION❑ ALTERATION❑ REPAIR❑ pOTHER I❑ /1 / USE OF STRUCTURE(Resideaq,Garage,Carnme i l Bldg Fri) GO/fl M��'Yif O+-, 6 ,�S rD( . IS USE: PRIMARYA SEASONAL❑ NUMBER OF BEDROOMS_C> NUMBER OF BATHROOMS 6 HEATED STRUCTURE? YES(Whaleald YES(rants)afB1dg)❑ NO❑ DESCRIBE WORK Canna bIS G rr�S SOEARE FOOTAGE:(P Pa 4 1ST FLOOR?/✓sq.$ 2ND FLOOR sq.sq.R 3RD FLOOR sq.fL BASEMENT•_,IVT sq.fL DECK_§A_sq.fL COVERED DECK MA sq.ft STORAGE_ _sq.fL OTHER sq.R GARAGE_sq.ft Attached❑ Detached❑ CARPORT_1✓A sq.ft Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MA> � QpEL YEAR LENGTH WIDTH BEDROOMS �13ATFi3 -• —'SERIAL NUMBER ENVIRONMENTAL HEALTH: " SEWAGE/SEWER SOURCE: SEPTICX SEWER❑ / NEWX EXISTING❑ PLUMBING IN STRUCTURE? YESO No❑ IJyes,attach completed Waler Adequacy Form PERINIETER/FOUNDAnON//DDR�RAINS PROPOSED? YE,$T NO[] EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS O 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 1 further de:fare that I am entitled to receive this permit and to do the work as proposed.1 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,his permfUapprication becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period al 180 days. PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATI 0 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42) X y—/c?, Signer re OWNER(Must be signed bythe OWNERI Date �EPARTIN=AL_REVIERr-_,---_ =!4PPROVED�== DATE``.:_DENIl�D_.:.bATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MAR CHAT. PUBLIC HEALTH MASON COUNTY COMMUNITY SERVICES Permit No: r�Id 26 1-4 r1b PERMIT ASSISTANCE CENTER: -BUILDING•PLANNING•PUBLIC HEALTH-FIRE MARSHAL 615 W.Alder Street,Shelton,WA 98584 Phone Shelton:(360)427--9670 ext 352•Fax:(360)427-7798 Phone BeNalr.(360)275-4467•Phone Elma:(360)482-5269 BUILDING PERMIT APPLICATION A/WE I V E.D PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: _52qn ;rby 8 NAME: CCT 15 2024 MAIL ING ADDRESS:_ 9:) MAILING ADDRESS: CITY: jAdA`/► STATE: hlA ZIP: 4 CITY: STATE: ZIP:__ �� Alder Street PHONE#1: c?�8 9 4 V PHONE: CELE- PHONE#2: EMAIL: EMAIL: L&I REG# EXP. / I PRIMARY CONTAC : OwNER K CONTRACTOR El OTHER P NAME EMAIL P.OV1 L.A r &14S 41 4ra+i! MAILING ADDRESS CITY STATE&.#A ZIP PHONE 240— r CELL PARCEL INFORMATION: r 1 l c 1 PARCEL NUMBER(12 Digit Number)'7.Z 0 d d- "aZ y``_ �C ',7L: ZONING �10V !`/� LEGAL DESCRIPTION(Abbreviated) ,? .S&A b DI`!/- .�G�-7 FIRE DISTRICT ceAt)-4.1- SITE ADDRESS 0)• We Gr 4 C� DIRECTION TO SITE ADDRESS ae /� Ta ui O O In1� zV1a GT -11 IS THE PROJECT WITEM-i 300 FT OF SLOPE(S)GREATER THAN 14°1: YES[] NOX SNOW LOAD: Psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Ch-k.tl M t pply): SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETI.AI D❑ SEASONAL RTINOFF❑ STREAM❑ TYPE OF WORK: NEWX ADDITION❑ ALTERATION❑ REPAIR❑ DOTHER ❑ USE OF STRUCTURE(Rrsfda+rl;Garage p+�e�S' po l IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS_(NUMBER OF BATHROOMS 6 HEATED STRUCTURE? YES(FVhaleB7dg>9_ YES ❑ NO❑ DESCRIBE WORK C_&^Aa bX&1_&yj S SQUARE FOOTAGE:(prop.:d) A 1ST FLOOR_4�0 sq.k 2ND FLOOR_Af6 sq. t. 3RD FLOOR_g4 sq.ft BASEMENT ,4/4 sq.fL DECK_#A_sq.fL COVERED DECK MA- sq.fL STORAGE_A&_sq.fL OTHER sq.R GARAGE_sq.ft Attached❑ Detached❑ CARPORT_6yA sq.ft.Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUH?ED* MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERL4I.NUMBER ENVIRONMENTAL HEALTH- SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ ! NEW❑ EXISTING❑ PLUMBING IN STRUCTURE? YES NO❑ Ifyes attach completed WaierA deg uacy Farm PERIMETER/FOUNDATION DRAINS PROPOSED? YE,VI` NO[] EXISTING SQ.FT. O EXISTING BEDROOMS PROPOSED BEDROOMS 4�> TOTALBEDROOMS Q OWNER acknowledges that submission of inaccurate information may result in a stop work order orpemlt revocation.Ac}mowledgement 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 v+ork as proposed.1 have _ obtained permission from an the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal representative,represerrts 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 pemittapplication becomes nun$void if work or authored 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 APPLICATI 0 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42) (� Signa re OWNER(Must be signed by the OWNER) Date 'DEPART AlENTAL =_°-PPROVED'.:`- DATE:= _D IEDr.:.DATL-.'fi_AGS)NOTES/CONDTITONS==_ BUILDING DEPARTMENT PLANNBdG DEPARTMENT FIRE NI A 12 SRA L PUBLIC HEALTH MASON COUNTY COMMUNITY SERVICES PermitNoX.bll 262,--066 7 C, PERMIT ASSISTANCE CENTER: .BUILDING•PLANNING-PUBLIC HEALTH•FIRE MARSHAL 615 W_AlderStreet,Shelton,WA98584 Phone Shelton:(350)427--9670 ext 352-Fax(360)427-7798 Phone I Belfair-(360)275-4467•Phone Elma:(360)482-5269 ` BUILDING PERMIT APPLICATION 4- i I V E D PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: zk -r. V g NAME: OCT 15 2024 NLMLING ADDRESS:_[6 MAILING ADDRESS' CITY:S>fiea6prA STATE:rJA- ZIP:—f M CITY: STATE: ZIP: Alder Street PHONE#1: �E,y-7S3 44 y PHONE: CELL: PHONE#2: EMAIL: EMAIL: L&I REG# EXP_ PRIMARY CONTAC : OwNER K�. CONTRACTOR El OTHER�] NAME ' 4EMAIL &W r DNS Loytq MAILING ADDRESS CITY STATE IAIA, _-_ZIP PHONE O— r4f CELL_ PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) y z 0 G Q- 'q oc 12 o _ZONING 7,.&y k7� LEGAL DESCRIPTION(Abbrcviatcd) 3 .Sµ b QLt a .�G 7 FIRE DISTRICT CCA1 X d-% I SITE ADDRESS A/. WGi-) Cl)- CITY ke- /l C/ DIRECTION TOSITEADDRESS dtey /d� TO &Wy 16d, r DAI IS THE PROJECT WTI Eli 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NOX SNOW LOAD:_psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (ch—k.ti hat pply): J/ SALTWATER❑ LAKE❑ RMKPJCREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF El STREAM❑/,L TYPE OF WORK: NEWA ADDITION❑ ALTERATION❑ REPAIR❑ DOTHER ❑ USE OF STRUCTURE(Rer d�a Garng,Comm�i.I Bldg,Da) C0W 1M*f�(� p/ +�����S VQ( ). IS USE: PRIMARYA SEASONAL❑ NUMBER OF BEDROOMS_5 NUMBER OF BATHROOMS 6 HEATED STRUCTURE? YES(nol�B YES(PartfsjafBLdg)❑ NO❑ DESCRIBE WORK CQAAa biS Gfi�&S SOUARE FOOTAGE:(pr po�4 A 1ST FLOOR0 sq.ft. 2ND FLOOR-_tldrsq.fL 3RD FLOOR_&� sq.fL BASEMENT *4 sq_fL DECK��Q__sq.fL COVERED DECK.�IT sq.ft. STORAGE_sq-ff OTHER sq.fL GARAGE_sq.ft.Attached❑ Detached❑ CARPORT _sq.ft Attached❑ Detached❑ MANUFACTi)RED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAILE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONAMNTAL HEALTH: - SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTING❑ PLUMBING IN STRUCTURE? YESO NO❑ Ifyes,attach completed Water.Adequacy Form PERRVfETER(FOUNDATION//DD�RA19S PROPOSED? YEV*T NO[] EXISTING SQ.FT. O EXISTING BEDROOMS CJ PROPOSED BEDROOMS TOTAL BEDROOMS 0 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 struchne(s)for review and inspection.This pernWappHcation becomes null$void if work or authorized construction is not commenced within 180 days or if construc ton 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 APPLICATI 0 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42) (, X Signa re or OWNER(Must be signed by the OWNER) J Date "TEPART11 ItTAL R7 E I1 :APPROVED`;:`- DATE= = DENIED DATE_:--TAGS/NOTES/CONDITIONS 2�: BUI DING DEPARTMENT PLANTNII 7G DEPARTMENT FIRE MARSHAL PUBLIC HEALTH MASON COUNTY COMMUNITY SERVICES Permit No: L60) 2_0 A - 00je)0 PERMIT ASSISTANCE CENTER: ,BUILDING•PLANNING-PUBLIC HEALTH-FIRE MARSHAL 615 W.Alder Street,Shelton,WA 98584 Phone Shelton:(360)427-9670 ezt 352-Fax(360)427-7798 Phone BeXalr(360)275-4467-Phone Elma:(360)482-5269 0� '�'V E I V E D BUILDING PERMIT APPLICATION �`1 PROPERTY OWNER L\TFOR``MATION: ..l p CONTRACTOR INFORMATION: O C T 15 2024 NAME- 52oy^ 1rU T `!D NAME- MA ING ADDRESS:_&M MAILING ADDRESS: 1 W. Alder Street CITY:,5A4 ri fA STATE:&J ZIP: ?� CITY: STATE: ZIP: PHONE#1: 36&�;7 8 g X PHONE: CELL-7— PHONE#2: EMAIL: EMAIL: 9.-& r9 L&I REG# EXP. l I PRIMARY CONTAC : OWNER K CONTRACTOR❑ OTHER�] NAME_ Selo" EMAIL goM G u� !NS �oit7 MAILINGADDRESS CITY S / /\ STATEbJA ZIP PHONE AO CELL?120— — PARCEL INFORMATION:PARCFL NUMBER(I2 Digit Number)y z 0 d a- •a y- �c�e� ei ZONING ,I&& 1`7�' LEGAL DESCRIPTION(Abbreviated) ,3 Sk b AV 11- FIRE DISTRICT C"l SITEADDRESs &)- 017, CITY cke- /A-"I 0.m c/ DIRECTION TO SITE ADDRESS w� W �T IS THE PROJECT WTTMN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NOX SNOW LOAD: psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Chwtall iharappty): SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEWA ADDITION❑ ALTERATION❑ R(E�PAI,R❑ QOTLIER ❑ USE OF STRUCTURE(Re id_ce,Gnrag�CammeraalBtdg,Etc) �/H�1J�1���-/ Q.4d, L�,S' 10, . IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS_Q_NUMBER OF BATHROOMS HEATED STRUCTURE? YES(nh it B YES(Partfsl afBMO❑ NO❑ DESCRIBE WORK CQjjka 4 j S -r&&j S SQUARE FOOTAGE:(Proposed) A 1ST FLOOR�T�sq.ft. 2ND FLOOR sq.fL 3RD FLOOR sq.ft BASEMENT �T s,fL DECK_AM_sq.fL COVERED DECK_ sq.fL STORAGE_/}_sq.fL OTHER sq.fL GARAGE_#47 sq.fL Attached❑ Detnehed❑ CARPORT_ Vy sq.$Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUHU D* MAKE MODEL LENGTH i WIDTH BEDROOMS BATHS SERIALNLTMBER ENVIRONMENTAL HEALTH: " SEWAGEISEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTING❑ PLUMBING IN STRUCTURE? YESO NO❑ Ifyes,attach completed Wafer Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YFV NO[] EXISTING SQ.FT. O EXISTING BEDROOMS © PROPOSED BEDROOMS TOTAL BEDROOMS Q 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 al!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 employers of Mason County access to the above described property and structure(s)for review and inspection.This permit/application becomes null&void ifwork 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 APPLICATION4EIDO DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.0&A2) Slgna re o,OWNER(Must be signed by the OWNERI Date bEPARTIS2EAT'fAI._REVIEW=_, ;APPROVED:-'==DATE:`:'_D >t]F,D_ .DATE`---' GS/NOTES/CONDITIONS==: BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLICHEALTH - I MASON COUNTY COMMUNITY SERVICES PermitNo:_, L/t'1�1 Zc2 — OXCS I PERMIT ASSISTANC CENTER: •BUILDING-PLANNING-PUBLIC HEALTH•FIREMARSHAL 615 W_Alder Street,Shelton,WA 98584 Phone Shelton:(360)427--9570 eat 352•Fax:(360)427-7798 Phone BeNair.(360)275-0467•Phone Elma:(360)482-5269 BUILDING PERMIT APPLICATION ' PROPERTY OWNER INFORMATION: A 'ATION: �Q CONTRACTOR INFORMATION: Q C T 15 2024 NAME: J^ k^ ;r6 7 *' NAME: MAMING ADDRESS:, l,Cn MAn NG ADDRESS: 615 W. Alder Street CITY:S14410ri► STATE:!JR ZLP:_S, CITY: STATE: ZIP: PHONE#1: 2,A j—78 4 J&g y PHONE: CELL: PHONE#2: EMAIL: EMAIL: sa.d� 01 L&I REG# ExP. ! / PRIMARY CONTACT: OwN'ER K CONTRACTOR❑ OTHER�] NAME Sa•01n / _ EMAIL 794S H eaAj MAILINGA➢DRESS IAA-Lt/COX CITY p U STATE-ZLP PHONE �?�a0 - aq SI CELL— _1_60-79 --Z61I If PARCEL INFORMATION: 1 PARCEL NUMBER(12 Digit Nuraber) yZeoa- -ag-"qa)-3t) ZONING JZ4&V4I` LEGAL DESCRIPTION Abbreviated) 3 Sx 6 Ai ff ,�G a-•7 FIRE DISTRICT CeA t" a SITE ADDRES S of WGs' G7' CITY � �/t cf DIRECTION TO SITE ADDRESS /0/ To Wy _/Oa. f O IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NOX SNOW LOAD: psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Chec8a8 that pply): SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WET AND❑ SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEWA ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(Rends ct C-rag,_Comm g-d"S P01 ). IS USE: PRIMARYA SEASONAL❑ NUMBER OF BEDROOMS_b NUMBER OF BATHROOMS_ HEATED STRUCTURE? YFS(WMr Bld YES Ppartf4 ofBldg)❑ NO❑ DESCRIBE WORK C_&^Aa4l S G-r&l.4 S SOUARE FOOTAGE:&npo 4 1ST FLOOR_40 sq_$ 2ND FLOOR sq,ft 3RD FLOOR sq.fL BASEMENT ,,4 1' sq.fL DECK AM_sq.R COVERED DECK A�ff sq.fL STORAGE_sq.fL OTHER sq.fL GARAGE__#_4:_sq.fL Attached❑ Detached❑ CARPORT_j" _sq.fL 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? YESO NO❑ Ifyes,attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YEV'T NO❑ MSTING SQ.FT. 0 EXISTING BEDROOMS lJ PROPOSED BEDROOMS TOTAL BEDROOMS C� OWNER acknowledges that submission of inaccurate information may insult 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 ifwork or authot¢ed 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 1S BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATI 0 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.OaA2) X ! -Auk Sign re OWNER(Must be signed by the OWNER) Date DEPARTMENTAL_REVIEW_ APPROVED"- DATE . _I3ENI166 DATE_`.-'-TAGS/NOTES/CON''DTTIONS S_ BUILDING DEPARTMENT PLANNWG DEPARTMENT FIRE MARSHAL PUBLIC HEALTH MASON COUNTY COMMUNITY SERVICES PermitNo:C�)m 202-4 •0066Z PERMIT ASSISTANCE CENTER: BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL 615 W.Alder Street,Shelton,WA 98594 Phone Shelton:(360)427-9670 ext 352•Far(360)427-7798 Phone Belfalr.(360)275-4467•Phone Elrna:(360)482-5269 BUILDING PERMIT APPLICATION gsA, PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: RECEIVED NAME. 51" k V M-1 ffi. MAILING ADDRESS: / / . MAMINGADDRESS:_ j 2U24 nr�l�— CITY:,SA4,,*A STATE:WA Z CIT IP:1M Y: STATE: ZIP: PHONE#1: PHONE: CELL: PHONE#2: EMAII n/ A I� r Street EMAIL: Ss.d1. Pl I L&I REG# FM. PRIMARY CONTAC OWNER K CONTRACTOR❑ OTHER ] NAME EMAIL 5e4m 4 A r &MS/✓ Gx! MAILINGADDRESS CITY * STATE xdA, ZIP PHONE O— CELL at Tat PARCEL INFORMATION: `, / ' c 1,,, PARCELNUMBER(12 Digit Number) yZ0O�'o��r — �VC) L' ZONING�OV► 1�7�' LEGAL DESCRIPTION Abbreviated) 3 $,,6 Di fl- 46-7-] FIRE DLSTRICT CG1 SITE ADDRESS 1Y I a/. WO—WW4 G CITY kAftA Awcl DIRECTION��S-�TOSITE ADDRESS Zd 0 W O c C L&W-16`/P& c:7- IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO X SNOW LOAD:_ —psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (C6eckatt that apply): J, SALTWATER❑ LASE❑ RIVEPJCREEK❑ POND❑ WETL AND❑ SEASONAL RUNOFF❑ AM❑/4 STRE TYPE OF WORK: NEW90 ADDITION❑ ALTERATION❑ REPAIR❑ OTHER1❑', USE OF STRUCTURE(Reddeaee,Garagq CommedalBld�Etc) Ca/NM�17/1 8+nJ�4/��S �� IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS BEATED STRUCTURE? YES(Whole Bld YES(FaTifrl of Bldg)[INO ElDESCRIBE WORK Canna 46; &.f&CJ S SOUARE FOOTAGE:(prop.,) 1ST FLOOR410 sq.& 2ND RIOOR _L)&sq.ft_ 3RD FLOOR y�A sq.ft. BASEMENT sq.fL DECK—sq.fL COVERED DECK#sq.fL STORAGE sq.fL OTHER sq.fL GARAGE__sq.R Attached❑ Detached❑ CARPORT__A�A sq.ft.Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIR10* MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIALNUMBER ENVIRONMENTAL HEALTH- SEWAGWSEWER SOURCE: SEPTIC SEWER❑ ! NEW❑ EXLSTING❑ PLUMBING IN STRUCTURE? YESO NO❑ IJyes,attach completed Water Adequacy Form PRRIMETEWFOUNDATION DRAINS PROPOSED? YE$rer' NO[] EXISTING SQ.FT. 0 EXISTING BEDROOMSC _ PROPOSED BEDROOMS TOTAL BEDROOMS O OWNER acknaMedges that submission of Inaccurate information may result In a stop umrk 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 pemnitlappliration becomes null$void if woric 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 APPLICATI 0 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42) X C�� Sign re OOWNER(Must be signed by the OWNERI f l ODaate `DEPARTMENTAL REVIEW :APPROVED'=' DATE` =DENIED_ :DATE="TAGSlNOTES/CO1gDITTONS'- BUILDING DEPARTMENT PLAIQNIIQG DEPARTMENT FIRE MARSHAL PUBLIC HEALTH