HomeMy WebLinkAboutCOM2023-00033 - COM CD Environmental Health Review - 4/11/2023 e'‘N.0.19- MASON COUNTY COMMUNITY SE' VIC j,S 4 rm • ,:0-0M 2OL"1J'DA) 7
PERMIT ASSISTANCE CENTER: '•t/"/�
.1). •BUILDING•PLANNING•PUBLIC HEALTH•FIRE ARSHAL , r 2O
5MI 615 W.Alder Street,Shelton,WA 98584 RECA* ?,� is E C E I V E D
:t. �` i,s' Phone Shelton:(360)427-9670 ext. 352•Fax:(360)427-7798 Pho . F�
y� Belfair:(360)275-4467•Phone Elma:(360)482-5269
ont°b'FI13,13 C1 APR 10 2023
BUILDING PERMIT APPLICATION
_�p� A Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFOgTI'ON'Ider _ _
NAME:Tim McMillin NAME:TBD lii Z
MAILING ADDRESS:1042 SE Bloomfield Rd MAILING ADDRESS: Z
CITY:Shelton STATE:WA ZIP:98594 CITY: STATE: ZIP: 4
PHONE#1:360 426 3354 PHONE: CELL: = Z
PHONE#2: EMAIL :
EMAIL:tbm@olympiaoyster.com L&I REG# EXP. / / "I
D
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER 0 r
NAME Steve Robert-Davido Consulting Group,Inc. EMAIL Steve@dcgengr.com
MAILING ADDRESS 9706 Fourth Ave NE,Suite 300 CITY Seattle STATE WA ZIP98115
PHONE (206)523-0024 x 138 CELL
PARCEL INFORMATION: I‘f I IL-1 -0000'
PARCEL NUMBER(12 Digit Number) 3192-14-00000 ZONING Neighborhood Residential
LEGAL DESCRIPTION(Abbreviated) GOVT LOT 1 EX&TAX 87&TAX 91 EX FIRE DISTRICT4 Station 42
SITE ADDRESS 1042 SE Bloomfield Rd CITY Shelton
DIRECTIONS TO SITE ADDRESS Turn right onto SE Old Olympic Hwy,Turn left into SE Bloomfield Rd,Turn right,1042 SE Bloomfield Rd
on the left.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO fl SNOW LOAD:15 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK❑ POND ❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW ❑ ADDITION 0 ALTERATION ❑ REPAIR ❑ OTHER 0Replacement
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)Over water Platform, Pier, Pilings, Gangway, Float, Breakwater,
IS USE: PRIMARY El SEASONAL ❑ NUMBER OF BEDROOMS N/A NUMBER OF BATHROOMS N/A
- HEATED STRUCTURE? YES(Whole Bldg) 0 YES(Part[s]of Bldg) 0 NO 0
DESCRIBE WORK Replacement/Rehabilitation project for Olympia Oyster Shellfish Processing Plant
SQUARE FOOTAGE: (proposed)
1ST FLOOR N/A sq.ft. 2ND FLOOR N/A sq. ft. 3RD FLOOR N/A sq.ft. BASEMENT N/A sq.ft.
DECK N/A sq. ft. COVERED DECK N/A sq.ft. STORAGE N/A sq.ft. OTHER 16,500 sq.ft.
GARAGE N/A sq.ft. Attached 0 Detached 0 CARPORT N/A sq. ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE N/A MODEL N/A YEAR N/A LENGTH N/A
WIDTH N/A BEDROOMS N/A BATHS N/A SERIAL NUMBER N/A
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC E SEWER ❑ / NEW ❑ EXISTING 0
PLUMBING IN STRUCTURE? YES ❑ NO 0 If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NOD EXISTING SQ.FT. N/A
EXISTING BEDROOMS N/A PROPOSED BEDROOMS N/A TOTAL BEDROOMS N/A
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&void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 1 0 days.
PROOF OF CONTINUATION OF WOR N THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
--AJ PLICA ION OF 180 OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
---- COUNTY CODE 14.08.42)
Signatur of OWNER us e signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL PUBLIC HEALTH 0A- 8(j4)J3 coy st/0 4 S ad/ at
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