HomeMy WebLinkAboutBLD2025-00054 Replace Piling - BLD Application - 1/16/2025 MASON COUNTY COMMUNITY SERVICES Permit No:Kho�Dogs—00b54
P,ERI{UTAS8/STANCE CENTER:•BUILDING•PLANNWG•PUBLIC HEALTH•F,✓Z AMARBH& RECEIVED
615 W.Alder Street,Shelton,WA W)84
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Phone Sh9A=(360)427-96M ext 352•Fen:(360)427-7798 Phone J A N 1 6 2025
BeNelr(960)M-4467•Phone Ernie:(360)482.&M
BUILDING PERMIT APPLICATION 615 W. Alder Sheet
PROPERTYO R CONTRACTOR INFORMATION•
NAME- R00e(t" F216K h0r`G
MAIL. A DRESS; p o r I�t
{� _ T_ 4AIL114 ADDRESS._ 0 t�l�N
CITY: Clielr✓ STATE: ZII':qa CITY: i Its STATE: ZIP:
PHONE#t: (�v 31 • S I,�y _ _
PHONE#2: - EMOAIL-� e,, P►r�:
EMAIL: o b INUOr GrZ cuv✓� L&I REG#— ECG
O C • {^�'�--*—^•— CONTRACTOR[] OTHER A6E;NT'
MAILING ADDRESS,5 JS�S'�'ll��l Y G G1 [. &N4A1L
PHONE IJ C CITY r1 ATE ZIP li
CELL
PA>fI;�L INFORMATION __..
PARCEL NUMBER(12 Digit Number) ZONING �? , Z _
LEGAL DESCRIPTION(Abbreviated)j FIRE DISTRICT
SITE ADDRESS 1 t��y_l L , _ A,(,` CITY
DIRECTIONS TO srrE ADDRESS Kt v ri WA ?a iy11(eS r + cM
IS THE PROJECT WITIHN 300 FT OF SLOPES)GREATER THAN'IA%: YESB NO❑
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (C eckaurhat"ply):
SALTWATERX LAKE[]-RIVER/CREEK❑ POND[] WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER PA1 j(f-(,L'yl'VA+-.
USE OF STRUCTURE(Heridence.Grade,CommerrialBlIg.Ple.) (/L ry
IS USE: PRIMARY❑ SEASONAL$Z NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES rwholeBllg)ElYES(Partld oJBldd)Fj NO❑
DESCRIBE WORK_U,
SQUARE FOOTAGE;(pwyme+
1ST FLOOR,_sq.fL 2ND FLOOR -_sq.fL 3RD FLOOR— -sq.ft BASEMENT sq.fL
DECK_ sq.ft. COVERED DECK---sq.fL STORAGE,_ sq.ft. OTHER
GARAGE sq.ft. Altached❑ sq.Detached❑ CARPORT d ft
ft. Attached❑ Dttached❑
MANUFACTURED HOME INFORMATION: •4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL------ YEAR LENGTH
WIDTH BEDROOMS BATHS-----SERIAL NUMBER
I;rNVIRONMI:NTAL HEALTH• —
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES❑ NO❑ 1f yes,attach complded Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO[] EXISTING SQ,FT.
EXISTING BEDROOMS PROPOSED BEDROOMS - TOTAL BEDROOMS
t)WNER aclooWedges that submealon d Inaccurate tnfonnatlon may result In a stop work order or permit revocatiom Admowedgement of such le signature below,I declare VW I am the owner and I turthsr declare that I am entibed to receive the permit and to do the worts es proposed I have by
obtained
�p�lselorr from all the necessary parties,Including any easement holder or Pardee of Interest regarding this project The owneror legal
and sit ntliti s)for a�the IMormallon provided Is accurate and grants employees d Meson County access to the above described property
Ir"don• This perniVapplloation becomes null&Vold If workor authorized oonetrucdon Is not commenced within 180
days or d oonstruction work is suspended fora period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT 18 BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 190 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 141IL42)
• OWNERbv via
Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSINOTRWCONnrfff DNB
BUILDING DEPARTMENT LJ
PLANNING DEPARTMENT ;--Lf 2.5 W udd
FIRE MARSHAL
PUBLIC HEALTH