HomeMy WebLinkAboutBLD2023-00464 - BLD CD Environmental Health Review - 4/27/2023 o>' t �1,, MASON COUNTY COMMUNITY SERVICES Permit No: 4P, S . L;f�
PERMIT ASSISTANCE CENTER: -eriij
. /_ 'I i •BUILDING••PLANNING•PUBLIC HEALTH•FIRE MARSHAL RECEIVED �v
• 615 W.Alder Street,Shelton,WA 98584 'r 0 8 l/;
�`,. Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone [U(3
Befaic(360)275-4467•Phone Elma:(360)482-5269 APR 2 7 2023 RECEIVED
BUILDING PERMIT APPLICA QN Un, Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:NAME:.I6)-7. t'tLf r7c"il,..67•47-1' -114, H NAME: 1-13,> ENV1RONIV1ENTAL
MAILING ADDRESS:2 3Ci.; ;Tit:),t?'4O.tl S 7 MAILING ADDRESS: �, /�
CITY:<9"G—ri./hc e,z.,STATE:i..,A ZIP: `,9"V:ffi CITY: STATE: ZIP:H EALTH
PHONE#1: PHONE: CELL:
PHONE#2: EMAIL:
EMAIL: j—)-i-y-c,--i Z►e.(,;vk4iL. GL,iI L&1 REG# EXP. / /
PRIMARY CONTACT: OWNER 0 CONTRACTOR❑ OTHER .
NAME "i,.1 L-/,t.V..r/ EMAIL'-r--.•+iP.,•90,4'✓li-rA'l.l.'(r' l74-`S-tG%-1 C411
MAILING ADDRESS /'j t- ,ic 'It'iL t_ri-te. g, .41 5,..- CITY r_I_`VIC','<at— STATE -"-i ZIP c'i Z_
PHONE SGG• `,r- f!e. 71 CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 2 7/' 2 /y C. )C)' C' ZONING_ /-.-
LEGAL DESCRIPTION(Abbrcviatcd) FIRE DISTRICT
SITE ADDRESS/10 ,= UI7LtrL-.,r4- r7.L CITY S"%JL. /t L)
DIRECTIONS TO SITE C_ADDRESS I fi.�`1 :i r(� -Vf lit.e...co. Air, / 54 S'" Li".) �ie.t/L;r..Jf
S..c,;o� 4ivi 1./��Y4s .(i '7,2 S, : CALL) 2-1Cl17-
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO.K
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE$1 RIVER/CREEK 0 POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEWX1 ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Etc) We"; L 1)r{f
IS USE: PRIMARY SEASONAL 0 NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 7
HEATED STRUCTURE? YES(Whole Bldg)0 YES(PartIsl of BldgN NO❑
DESCRIBE WORK /..J:5-1... S.,.it C.t.' A'i 1-7,t.1 12 c'S i ii-A,-7.4.'c
SQUARE FOOTAGE:(propose+existing)
1ST FLOOR"2.,r iC sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT f 74... sq.ft
DECK/ 2-`7) sq.ft. COVERED DECK 6,S 1 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE!'a 33c. sq.ft Attached Detached❑ CARPORT sq.ft. Attached❑ Detached E
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC la SEWER 0 / NEW Ef. EXISTING❑
PLUMBING IN STRUCTURE? YESg NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES is NOD EXISTING SQ.FT. l—'
EXISTING BEDROOMS C.: PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
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 permiliappiication becomes null&void If work or authorized construction Is not commenced within 180
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 APPLICATION OF 18 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X9jLjq /Z7 / 2.02toOWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED. DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH famr 6(?7,173 l.CA )- i J
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DESIGN BY: TATOY RESIDENCE
TIM L. 240 E LAKEWAY DR _�
SHELTON,WA98584 ADAM LANEER DESIGN
DATE:04/19/23 «.,w•.4