HomeMy WebLinkAboutBLD2022-01513 - BLD CD Environmental Health Review - 12/7/2022 a�"````' MASON COUNTY COMMUNITY SERVICES Permit No: � id �ZZ
PERMIT ASSISTANCE CENTER: R j
Y
7. •BUILDING•PLANNING.PUBLIC HEALTH•FIRE MARSHAL E C L I V EC
- ' t- ^4 615 W.Alder Street,Shelton,WA 98584
%y` v4- P. Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
r,
Belfair.(360)275 4467•Phone Elma:(360)482-5269 DEC 0 7 2022
BUILDING PERMIT APPLICATION
615 W. Alder Street
PROPERTY OWNER INFORMATION: I CONTRACTOR INFORMATION:
NAME: } 1 uc/ ed 04
MAILING ADJ�RESS:101 (,�3. E`.
CITY5( -^ STATE:LON. ZIP: 171
PHOTfE#I: •S 60
PHONE#2:
EMAIL:
PRIM Y CONTACT: ,, OWNERS CONTRACTOR OTHER❑ ,,t L Y
NAME '�� �O�WS EMAIL ' ll�Lbu\L j \C .jZe`( Wall I , Py-,
MAILING ADDRESS • 1 I . CITY_ t fnnn STATELL ZIP
PHONE G.0 —2 .L CELL /i !( it
PARCEL INFORMATION: //�� n
PARCEL NUMBER(12 Digit Number) 9.21a1�^// -- 9WS/ ZONING (�
LEGAL DESCRIPTION(Abbreviated),1-C+ / :f $I / L�or/zEFIRE DISTRICT
SITE ADDRESS ,E . S'l4 oxe-i- Ic7G CITY 51ti1 IicsA.
DIRECTIONS TO SITE ADDRESS —c---
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO g SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all ihm apply:
SALTWATER❑ LAKE❑ RIVER/CREEK 0 POND 0 WETLAND SEASONAL RUNOFF( STREAM 0
TYPE OF WORK: NEWr, ADDITION❑ ALTERATION 0 REPAIR❑_a OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) V -e-1N-� e ti O€_v—c_ e
IS USE: PRIMARY 1 SEASONAL❑ NUMBER OF BEDROOMS -3 NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Pan/s]oj ldg)❑ NO❑
DESCRIBE WORK 6,,11) 1,•\�w3 a 6 e.6r0 NVN. R R rae-a,c_.-Q
SQUARE FOOTAGE: (proposed)
1ST FLOOR J q 13 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft
DECK 2.5.7 sq.ft. COVERED DECK Nil sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE_sq.ft. Attached® Detached 0 CARPORT sq.ft. Attached 0 Detached❑
MA D HOME INFORMATION: *4 COPIES OF THE FLOOR PLA *
MAKE MODE R LENGTH
I WIDTH — t3ED OMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NE EXISTING 0
PLUMBING IN STRUCTURE? Y NO❑ yes,attach ompleted Water Adequacy Form �j )
EXISTING SQ.
PERI ION DRAIN PROPOSED?PROPOSED BEDR S MS � N� TOTAL BEDROOMS FT3 / /
EXISTING 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 declare 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 access to the above described property
and structure(s)for review and inspection. This permit/application becomes null 8 void if work or authorized construction is not commenced within 160
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATI OF 180 DAYS OF ORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
c COUN CODE 14.08.42)
X 12.".S— 22
NER(Must be signed by the OWNER) Date
l
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHALr�
PUBLIC HEALTH \ la • C (1 \t + J G��Cf4 i
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