HomeMy WebLinkAboutCOM2025-00010 - BLD Application - 2/4/2025 MASON COUNTY COMMUNITY SERVICES Permit No:
PERAN ASSISTANCECENTER:
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BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: ONTRACTOR INFORMATION:
= 9HLMenP L.f NAME: TBD
MAILING ADDRESS: oR MAILING ADDRESS:
CITY:Corvallis STATE:OR ZIP:97339 CITY: STATE: ZIP:
PHONE#1:Ffr�=59TT PHONE: CELL:
PHONE 42: EMAIL
EMAI,:matt c er OO .com IRI REG# EXP.
PRIMARY CONTACT: OWNER❑ CONTRACTOR Drum(5
NAMB�1'yld- 1,1ldgNa++/frnewnn�px'ar*w EMAIICcalla han@ reenter farrow.com
MAILING AD DRESS S9iq Sandbugat Ln.#2n5 cmua as STATE T% 21PT520E
PHONE 502-299�TA CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 D,KNumbs) 12329-41-90230 ZONING GC UGA
LEGALDESCRIPTION(Abh eftO OREDISTUCT Belfair
SITEADDRESS23940 NE SR WA-3 CITY Belfair
DIRECTIONSTOSITEADDRESS Corner of NE Clifton Lo and SR 3.
STHEPRIMECi WTTHINSMFTOFSLOPEIS)GREATERTRANI414: YESO MR
MPROPERTYWTIHIH2O0FTOFTHEFOLLOWMG: rrhw#eonsgNN
SALTWATER❑ LAKE❑ RIVERICREEKD POND❑ WETLAND[] SEASONALRUNOFF❑ STREAM[]
TYPE OF WORK: NEW❑ ADDITION D ALTERATION[J REPAIR❑ OTHER TI i
USEOFSTRUCTURE%(Aeabe..certx.cowF.x N4c Ew) Comnercial - Grocery Store
ISUSE'. PRIMARYO SyYEEEASONALBB❑001� NUMBER OF BEDROOMS TTll NUMBEROFBATmow 2
HEATED STRUCT�ant3flteoaC'ofYe MWggr-ge:2ry Nsttlte including partitions,
DESCRIBE WORK MR
SOUARE FOOTAGE:(P.oPev x�mep
ISTFLOORTTySeq.ft 2NDFL0oR %, ft. TIRE FLOOR r9.ft BASEMENT_p.A
DECK u, R. COVERED DECK_tq.ft. STORAGE rq.ft OTHER m.R.
GARAGE rq.R AllgAed❑ Dmew❑ CARPORT p.R AlleheJ❑ DNaeMdo
MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLOOR PLAN REQUIRED'
MARE NSA MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERLLLNUMBER
IEWIRONMENTAL.HEALTW
SEWAGFISEWERSOURCE. SEPTIC SEWER® / NEW EMSTWG[F}
PLUMBINGINSTRUCTURE? YESQ NOD IIfWs wmeh avnylemd Wwu Adgg Foem
PERIMETEPvTOUNDATION DRAINS PROPOSED' YESD NON EMSIINGSQ.FT.
EKISTMG BEDROOMS NSA PROPOSEDSIDROOMS_ _. TOI AL BEDROOMS
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PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 10 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE SEEMED.(MASON
COUNTY LODE U.OE.12)
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DEPARTMENTALREVIEW I APPROVED DATE I DENIED DATL TACSMOTLSN:ONDITIONS
BUILDING DEPARTMENT
PLAWNMGDEPARTMENT
HRE MARSHAL
PUBLIC HEALTH
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