HomeMy WebLinkAboutBLD2024-01435 Addition - BLD Application - 12/5/2024 MASON COUNTY COMMUNITY SERVICES PermitNa: BLWpaO o4Lh..J
PERMIT ASSISTANCE CENTER: £ f,
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584 C (�
• Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7796 Phone +�*'4- E1
Betfair-(360)2754467•Phone Elms:(360)482-52S9
BUILDING PERMIT APPLICATION 15 W. Alder Sk-eet
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: �QI'NPS Doi to NAME: I �c
MAILING ADDRESS:_2'{i E q `f MAILING ADDRESS:_fit I_
CITY:am nev STATE: w ZIP: CITY: STATE: av ,ZIP:c g S
PHONE#1: V l0 11:7 '7 4 PHONE., CELL z
PHONE#2: EMAIL: c,��r. ,r p cl�, pEMAIL: �l rIN
L&I RE L L71-N _EXP.a^/Z57-2Qi.5
PRIMARY CONTACT: OWNER❑ CONTRACTOR OTHER❑ (
NAME , !A V-Aie-S 1 EMAIL Iry` � .Pr r_ii �t}
MARJNGAp DRESS WC-' e CITY � STA�__ZIP 1
PHONE �i�O 0 1 X{S I rj CELL_ (�{) • f� Z
*I PARCEL,INFORMATION:
PARCELNUMBER(12 Digit Numbcr) .21�D�-S�"p409� ZONING yn-R
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT S
SITE ADDRESS A61 / G r• CITY Y_TwI I
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPF.(S)GREATER THAN 14%: YES[] NO A SNOW LOAD:-.7,9 psf
IS PROPFRTY WITHIN 200 FT OF THE FOLLOWING; (Checkalt thot apply);
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITIONX ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(B—idence,Gnrng�.Commarcfa7B1dg,Pre) 5 1 C I P r1 I"tl
IS USE: PRIMARY R SEASONAL❑ NUMBER OF BEDROOMS_NUMBER OF BATHROOMS_
HEATED STRUCTURE? YES(WboleBzdg) YES(ParfA1)fB dg)❑ NO❑
DESCRIBE WORK
SQUARE FOOTAGE:(propuscd)
1ST FLOOR `4i sq.ft 2ND FLOOR sq-R 3RD FLOOR sq.ft- BASEMENT sq,tL
DECK sq.fL COVERED DECK sq.fL STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.f- Attached Detached❑ CARPORT sq.ft-Attached❑ Detached❑
MANORACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIALNUMBER
ENVIRONMENTAL HEALTH: -
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTING
PLUMBING IN STRUCTURE7 YES�5 NO❑ Ifyes,attach completed Water Adequacy Far
PERWETER/FOLNDATION DRAINS PROPOSED? YES❑ NO[� EXISTING SQ.FT. "tf 0
EXISTING BEDROOMS PROPOSED BEDROOMS 0 TOTAL BEDROOMS L
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 1 am the owner and I further declare that I am entitled to receive this permtl and to do the work as proposed.I have
obtained permission from ap 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 petmittapplication 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,
PROOFOF 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 14.0&42)
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- .._• _ .
: PPROVED. DATE' DENIED .:_DATE, TAGS)NOTES/CONDITIONS_C
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH