HomeMy WebLinkAboutBLD2019-00918 Cancelled Cover for Deck - BLD Application - 8/20/2019 �N MASON COUNTY COMMUNITY SERVICES �U //�
PERMIT ASSISTANCE CENTER: Permit Nw t ,961 q •W(q I g
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584
Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7796 Phone
BeHair.(360)2754467•Phone Elms:(360)4825269
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BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: R i CfkrdC i J NAME:
MAILING ADDRESS: 0 W QN�b0+v L MAILING ADDRESS:
U CITY: 6 i r STATE:Np ZIP: 8S2$ CITY: STATE: ZIP:
PHONE#I: O 1 PHONE: CELL:
A)PHONE#2: 0 - go 1 - EMAIL:
EMAIL: L&I REG# EXP.
PRIMARY CONTACT: OWNER❑.—CONTRACTOR OTHERp
NAME C EMAIL Gi p (_'�he♦1hq►1 �'Dri►
MAILING DRESS W 1 CITY 1t STATE ZIP
PHONE V - E 1— CELL
V PARCEL INFORMATION:
• PARCEL NUMBER(12 Digit Number)C;ozaS-50- 07-00 ( ZONING
LEGAL DESCR97ION(Abbreviated) 2 1 659 On SrWOFIRE DISTRICT
SITE ADDRESS 100 0 E Rai n 01+ L W CITY soy,�-Q, , \lif}gpS2
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checkall that pry):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLfD❑ SEArNALRUNOFF[1 STREAM❑
TYPE OF WORK: NEW ADDITION❑ AL TION[] PAI OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)
IS USE: PRIMARY.Je'SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCT y yy�YES(WholeBw))rI arr[s]�fBtdg)❑ N
DESCRIBE WORK
LT�CA/Y.1 V
SQUARE FOOTAGE:( +existing)
I OR_ sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
ECI _sq.ft. CO RED DE _I STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. A hed❑ Vhed❑ CARPORT�sq.ft. Attached❑ Detached)<
�( NUFACTURED HOME INFORM T`I0 • *4 COPIES OF THE FLOOR PLAN REQUIRED*
r1\� AKE Ytt t04MOD 1-1 YEAR 'q_9,LENGTH `C!X 1'
IDTH- BEDROOM S BATH SERIAL NUMBER
E VIRONMENTAL HEALT
SE GE/SEWER SOURCE: SE C SEWER❑ / NEW❑ EXISTING❑ t
PL GIN STRUCTURE? ❑ NO L7 Ijyes,attach comp ted Water Adequacy Form
PEN RIME D S PROPOSED? YES❑ NO17 EXISTING SQ.FT. '
EXISTING OOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER acknowledges 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 1 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 f work or authorized construction is not commenced within 1W
days or I construction work is suspended for a per. of 180 days.
PROOF OF CONTINUATION OF WO K ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 D S OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42) y z0 I
X I
ignature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE I TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH