HomeMy WebLinkAboutBLD2025-00458 Repairs - BLD Application - 4/14/2025 MASON COUNTY COMMUNITY SERVICES Permit No: ,Z—�Q VU
PERMIT ASSISTANCE CENTER: }
•BUILDING-PLANNING.PUBLtC HEALTH•FIRE MARSHAL RE j
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615W.Akker$trea Shahan WA95564 py
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Phone Shelor ri6W27-W0 ext 352•Aw PW)427-7798 Phan APR {I
Baifah-(360j27$4467.Phone Efrna:(360)482-5M 00 ~'
BUILDING PERMIT APPLICATION 615 W. Ndef Street
PROPERTY OWNER LNFORMATION: CON-17RACTOR RNFORMATION-
NAME: PxC*- �cal�t<f�4i1ti4'E�L NAME:�RrC{�� t�'lCS'1 E'A f r
MAILING ADDRESS:� l± J MAILING ADDR S
C1TY; j STATE:4 ZIP: _ CTY: ST E _ZIP:
PHONE#1: 2ra„ PHONt-w7-,
PHO14E#2: EMAIL.: �
EMAIL: L&I REG# EXP. !_!
PRIMARY CONT CT: OWNER❑ CONTRACTOR Nr
NAME EMAIL S(`f TAT'_r �_� {�
MAILING ADDRESS O. - 6 -3 CITY STATE N" _ZiP� t�z
PHONE MIA CELL 6
PARCEL INFORMATION:
PARCEI.NUMBER(12 Digit Number) e7/�..- ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS i E` GAf 1. CITY f�N EY-y
DnZECTTONS TO SITE ADDRESS. tL j N• �"V U(/44
IS THE PROJEC I!WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NA SN OW LOAD:,5gsf
IS PROPERTY WITT3TiV 20O FT OF THE FOLLOWING: (Ckcd aU ramp*):
SALTWATER❑ LASE❑ RTVERtCJtEEK Q POND[] Wr71.A*D d SEASONAL RUNOFF❑ STREAM
TYPE OF WORK: NEW Q ADDITION❑ ALTERATION❑ REPALM OTHER ❑
USE OF STRUCTURE 0kddsox Gmvgs,ComearcaJBTdyEtc) R .rtTi�3J
IS USE: PRLMARYtR!, SEASONAL[] NLhMBI OF BEDROOMS lv'LwER OF BATHROOMS .Z
HEATED STRUCTURE? tYp�E�SS M k 3M j0�-` YES(F Bt well NO❑
DESCRIBE WORK This .r i s.t � K�.-
SQUARE FOOTAGE:6,->.,4
1 ST FLOOR _sq.I 2ND FLOOR sq.fL 3RD FLOOR sq.fL BASEMENT sq.&
DECK %.8. COVERED DECK sq.fG STORAGE sq.ft. OTHER sq.R
GARAGE _sq.& Attached❑ Detached❑ CARPORT sq.&Attached Dazaehed❑
NW14-UFACTU'RED HOME LNFORM1iATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WMTH BEDROOMS BATHS SERIALNIJMBER
ENVIROIy'4 EN''TAL HEALTH:
SEiWAGEISE WER SOURCE: SEPTIC j SEWER❑ I NEW EXISTING/
PLL'MBLNG IN STRUCTURE? YES[� NO❑ .0 y ,attach cmVIefed Waler Adequacy Farm
PERIMFTERIFOUNDATION DRAINS PROPOSED? YES❑ NO�]i` EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER ages 0'at submission of ku raie information may mwd in a stop work order or parnit revue Adawwiedgement d such is by
signature below.I declare that I am tM owner and I turner declare that I am entitled to readve*ft permit"to do the work as pad.I twm
obtained permission from s@ tl»necessary parties,hckdit any easement Inkier or parties of irttessst regarding ttfs project.Thor owner or legsi
representative,represents tat tive Infomatlort provided Is accurate and grants ampicyees of Mason County access to the above described property
and shuetwe(sj for review and Inspecdor.This permMeppfication becomes rust 3 void Ir work or auswtfzed construed Is not commenced vftin 180
days or if oornsbucilon work Is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK OP THIS PERMIT IS BY MEANS OF INSPECTION. INACTWTTY OF THIS
PERMIT N OF 6Ian DAYS MORE CAUSE THE APPLICATION TO BE EXPIRED.(MASON
CODE t4.aa.42)
x l _
Sig ER the OWNE 1we
DEPQR, VIAL W �� ItQVED; TD?I '.: {_DYrNI30) DATIr sTAGSI}etOTESiCQ)NDTTIQvtS '
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
MASON COUNTY Shelton(360)427-9670 ext.352
DEPARTMENT OF COMMUNITY SERVICES Belfair(360)275-4467
Mason County Bldg. 8, 615 W. Alder Street
a Elma(360)482-5269
Shelton, WA 98584
�> www.co.mason.wa.us
REQUEST FOR BUILDING PERMIT EXPEDITION
Date: 14 laoo
Permit No.: 13 L 26915--f 466
Name: KAr'G haksa,
Mailing Address: �i E ', GLck Pi vy,- LEA
U1ir101 r wll� /b-43Z'111�
Parcel Number: 32 l b-4 -e o- oo )o6
Site Address: 5 1 E J" ?i k\x— %U'1
i r Y,
Request due to: ❑Medical Hardship ❑Fire Damage tether '1'ree,
Explanation of Hardship: �a� ""�rf PA 77 4zKr-7"5'4 GLS= 5'F A
F.rf,r7T 111 ZS Xt� iv �,cc,r( dT
Must include supporting documents.This may be a letter from a doctor, insurance claim report, report of fire damage
from appropriate fire district representative or other relevant documentation.
I (WE) understand the intention of this form to determine and document justification for expedition of a building
permit to alter or reconstruct a struc re he a ve n m r perty.
Signature Owner/Agent:
P/71 ApL.GA-7
OFFICIAL USE ONLY
Request: A Approved ❑Denied Date: 2S
Request denied for the following reasons:
Signature:
Director of Community Services
1. Datl ECEI V E®
MASON COUNTY APR 14 2025
COMMUNITY DEVELOPMENT 615 W. Alder Street
Permit Assistance Center,Building,Planning
Permit#: -�
Property Owner's Authorization Letter
Name i �G�. J11�I�GIS
Mailing Address I �AClIP�h1b �rJ
City 6� Jzf_� State lvJO ZIP
Phonq,"ZS�3> -73Z 79 Email
Parcel Number
Site Address�!. r � �,C4
City uzjl � State WA ZIP
I(we): TGl/JK�IyUU'�5��,
(Property Owners Name)
Hereby Authorize: (-Ur" KOAL--b12— f /VCa2 nt ;
(Name of PersoWContractor to Sign Permit)
To apply for, sign, and pick-up building permits for the following proposed work:
�'tS�1C�sl�IG i TU;Z5 5'TRTKf::� M PR-cf-C
(Brief Description of Work to be Done)
As property owner(s),I(we)hereby grant permission to the applicant referenced above to apply for,sign,and pick-
up the building permit for the work as indicated above. All work performed must meet all provisions of the
Building Codes and the Laws of Mason County and the State of Washington, as applicable,whether specified or
not.Resi ential Contracto are re used to have a current State of Washington Contractors License(RCW 18.27),
(Prope Owner St ture) (Date)
IDMASON COUNTY
COMMUNITY SERVICES
Budding Planning ErnirmmmN Hnldt Cammuniy Nedd
Name ,f CT�p��)V_Se l Permit#: (�L�(/�V�.J l -
Determination
Occupancy Type Square Footage Valuation Amount Total Valuation
g
:iJ 'w ��� ;; (Ve) (sq. ft. x valuation)
1. a 'L:..
Residence/Addition/Basement $167.37 $
Garage/Storage $66.48 $
Unfinished Basement $31.50 $
Deck $17.00 $
Carport/Covered Deck $24.00 $
Other $ 60 5 f
TOTAL VALUATION $ 60, 02 s 5 l
Estimated Plan Review Fee: $
Planning Dept. Review Fee [$275, $450, $100]: $
Environmental Health Review Fee: $
Fire Access & Grade Review Fee [$97.00]. $
ADD - Address Application Fee [$185.00]. $
GEO - Geo-technical Review Fee [$300.00]: $
ADV - Review Fee[$130.00] $
WAT - WAT Fee:
Other: TOTAL DUE WHEN PERMIT IS SUBMITTED: $ - I j
��• a�
The estimated plan review fee is based upon information provided at the time of application and is subject to change. Planning
Department fee is a flat fee which is due when permit is submitted. Building permit fee, mechanical fees, and plumbing permit fees
will be calculated during plan review. The balance of all other fees will be collected when permit is issued.
ESTIMATED BUILDING PERMIT FEES
Building Permit Fee (ICC, Table 1 — Building Valuation Data) $ -7060
/oZ
Estimated Mechanical Fees (U.M.C., Table 1-A). $
Estimated Plumbing Fees (U.P.C. ,Table 1-1) $
State Fee: $25 $6.50 $ 50
Technology Surcharge: 3,3-7
Other: $
Estimated Building Permit Fees WHEN PERMIT IS READY for pickup: $
(*all fees subject to change w/o notice) GRAND TOTAL $ , i I g e t1_7