HomeMy WebLinkAboutBLD2024-00312 Frame 2nd Story Floor - BLD Application - 3/8/2024 `ma c MASON COUNTY COMMUNITY SERVICES Permit 10: ' 003/ 0
PERMIT ASSISTANCE CENTER:
t "d��t� .BUILDING.PLANNING•PUBLIC HEALTH.FIRE MARSHAL RECEIVED
1 fiiM 615 W.Alder Street,Shelton,WA 98584
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Phone Shelton:136G427-9070 exi 352•Fax:(360)427-7798 Prow
Beftr.(360)2751467•Phone Elms.(360)482-5269
BUILDING PERMIT APPLICATION MAR - 8 2024 y
:_.3 k' y
1 PROPERTY OWNER INFORMATION`: ' CONTRACTOR AW T ; ,e r street
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NAME: w N S Q•
MAILING ADDRESS:,;telz Y.C. Dtlwul%,�F. D,';'. MAILING ADDRESS: 5 A tM dF-
j CITY:S 11'Ii4T'gr.' STATE:wA- ZIP:gR�¢ CITY: STATE: ZIP:
PHONE 41: e1 o b 7 L-•!;4- PHO\'E-: CELL:r3 o6 --$;5"-7d5¢;
PHONE r 2; i EMAIL:
EMAIL:r►'It,�u_�R! C tLS SN. Cy•Yl LEI REG# FXP._i l
PRIMARY CONTACT: OWNER( CONTRACTOR n OTHER❑ E
NAME Wo 7—
EMAIL
MAILING ADDRESS . 76 L-J ,CITY STATE i Ly ZIP —
PHONE CELL -Jr2t, Ri t- 7A;�=e
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 2 9,Q ;2 e . 0 a -;?-'ZONING
LEGAL DESCRIPTION(Abbreviated) I-eT1 t✓�'- S.P_ rtLS/+F41211e 61 FIREDISTRICT j
SITE ADDRESS „Z 2? <—f 7. �s l� g .✓ I� lQ. CITY S/{£G.T'C'?AJ E
DIRECTIONS TO SITE ADDRESS O fC:f,-.
i
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YL-S NO1g- SN-- OW LOADJ—Tpsf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check a1I rhaigw)l: !
SALTWATER❑ LAKE❑ RIVERCREEK] PON-D iD WETLAND❑ SEASONAL RUNOFF[11 STREAM
TYPE OF WORK: NEW..:] ADDITION[ ALTERATION R� REPAIR` OTHER
USE OF STRUCTURE(Residence.Gwzwe.Cemnercaad Rug.Ere.) f D ChtG
IS USE: PRIMARY'X SEASONAL❑ NUMBER OF BEDROOMS_3 NUMBER OF BATHROOMS_
HEATED STRUCTURE? YES 41-..k BkW,% YES dPariA1,l`B1drj❑ NO
DESCRIBE WORK Q fi I N I b, 541 41— Fl-c K C N 5' o+-d-:li TO
SQUARE FOOTAGE,:
IST FLOOR tt 2ND FLOOR i s ft. 3RD FLOOR_ h BASEMENT s R I
sq. q• _—sq.�. q- l
DECK sq,ft. COVERED DECK sq,ft. STORAGE _sq.ft. OTHER sq.ft. 1
GARAGE sq.fL Anached[] Detached❑ CARPORT sq.ft ,4nached[ Detached I,j i
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
i SEWAGE/SEWER SOURCE: SEPTIC g SEWER I NEW❑ EXISTINGg
PLUMBING IN STRUCTURE? YES❑ NO❑ ljlrs,attach completed WaterAdegaacy Farm 74-5
PERIMETERIFOUNDATION DRAINS PROPOSED? YES❑ NOg EXISTING SQ.FT. �`d
i EXISTING BEDROOMS 3 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 deciare 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 arise to theabove descTiSed property
and structurets)for review and inspection. This permWappticatiori Gekbrnei null E void if work or authorized constn:cticn s no!commenced within 180
days or if construction work is suspended for a period of':80 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PER APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14,08.42)
Signature of OWNER(Must be signed by the OWNER} Date
DEPARTMENTAL REVIEW APPRON-FD Q11TF DENIM DATE TAGS,'NOTES/CONDITIONS
BUILDING DEPARTMENT o '- 1q 1
PLANNING DEPARTMENT I
FIRE MARSHAL
PUBLIC HEALTH