HomeMy WebLinkAboutBLD2023-00818 - BLD CD Environmental Health Review - 7/20/2023 exiiise
.0' • 44 MASON COUNTY COMMUNITY SERVICES Permit]' lei ()
PERMIT ASSISTANCE CENTER: , `
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
l •0 615 W.Alder Street,Shelton,WA 98584 J U L 17 2023 MN
y.V •'--- 1 Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone
- " e Belfair.(360)275-4467•Phone Elma(360)482-5269
-•rL't"d`'
BUILDING PERMIT APPLICATION 615 W. Alder Street • JUL 2 0 2023
PROPERTY OWNERINFORMATION: CONTRACTO INFORMATION: FBGEIVED
NAME: 14ri C F W Cr 5 NAME: /V
MAIL SS:37J E�-s'r..sti .'el/ (. t_ MAILING AD 4SS: Z
CITY:�� TA C STATE:W'` ZIP: 1Y� CITY: STATE: ZIP: u.I
PHONE#1: 3e,) — 7i`�—. (734. PHONE: CELL:
—PHONE#2: EMAIL: Z Q
EMAIL: L&I REG# EXP. / / QQ
PRIMAR ONTACT: OWNER CONTRACTOR❑ OTHER❑ 7,2 ^ / FnWNAME f C ��L d:/ ` EMAIL /1 ,i�. y-3 if4 07�1 -! t - . sir-
MAILING ADDRESS 3 E AJV i ea) C./1 �_ T CL.•e/J STATE tz) ZIP�i'�ay`
PHONE CELL /734-, R.'
• PARCEL INFORMATION: 374
2-17
PARCEL NUMBER(12 Digit Number) J ` (( ZONING J�S
LEGAL DESCRIPTION(Abbreviated ,. /` ' /JW'\\ /* /0 G Of - S G`71- FIRE DISTRICTSITE ADDRESS 373 16 EF,A) V/e w ( CITY 3/1-f�L.TJ*)
• DIRECTIONS TO SITE ADDRESS
IS THE PROTECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO❑ SNOW LOAD:2-psf
. IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Cheek all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW A( ADDITION❑ ALTERAATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Resider,Garage CammeralaLaza&El.) /`-�TIe) 5 7 0 6/ e .
IS USE: PRIMARY% SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(MholeR1 g)off YES(Fortis]of Bldg)❑ NO❑
DESCRIBE WORK it,w , -Es/LC/O "
SOUARE FOOTAGE:(proposed)
1ST FLOOR CSC'n sq.R 2ND FLOOR'1 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.2
DECK s ft COVERED DECK T�5 sq.ft. STORAGE sq.ft OTHER _ sq.ft.
GARAGE sq.ft Attached,/Detached❑ CARPORT sq.ft.Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF Mk,FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
$i$7TI BEDROOMSEBLAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC l4 SEWER❑ / NEW% EXISTING❑
PLUMBING IN STRUCTURE? YES ( NO❑ .l yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES k NOD EXISTING SQ.FT.
•
EXISTING STING BEDROOMS PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
OWNER acknowledges that submission of inaccurate information may result In a stop work order or penny revo Lion.Acknowledgement of such is by
signature below.I declare that I am the owner and I further declare that I em entitled to receive this permit and to do the work es proposed.I have •
obtained permission from all the necessary parses,including arty easement holder or parties of interest regarding this project The owner or legal
representative,represent that the information provided is accurate and grants employees of Mason County ac,,s to the above described property
and structures)for review and inspection.This permit/application becomes null&void if work or authorized construction is no;commenced within 180
days or if construction work is suspended for a period of 1 B0 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICA N T BE EXPIRED.(MASON
, COUNTY CODE 14.08.42)
x b � 2 � 7 /✓ 7:32_--3
Simi tee of OWNER(Mu a signed by the OWNER) !Date —
{DEPARTMFIQTAL REVIEW= -.:i 14PPRQYED"='-DATE-..:r DENIED_.::DATE^ TAGS/NOTES/CONDITTONS''�:
BUILDING DEPARTMENT
PLANNING DEPARTMENT •
FIRE MARSHAL t � p
PUBLIC HEALTHf L0 � C.o`�C3 T
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