HomeMy WebLinkAboutBLD2021-00997 - BLD CD Environmental Health Review - 6/28/2021 MASON COUNTY COMMUNITY SERVICES Permit NO:aI LQR),aL{_n(/997
PERMIT ASSISTANCE CENTER:
.BUILDING•PUNNING.PUBLIC HEALIN•FIREWRSWL
615W Aden 8hee1,5W.F .060)40 RECEIVED er,'7
Pnwn SMXr..'( ))a2]-g6T4 eMade•Fac(3B0)<Y) 2159 Plcre
9pYair.(3Bg)2>S�aBI•Pnare Elms:(3BONBPSR6g
BUILDING PERMIT APPLICATIOWu 2 3 2021
PROPERTY OWNER INFORMATION: 7NAW:
RNFORMN879ffi NJIRNMENTAL
NAME: Uon KY\0. - tMAR,ING ADDRESS: OoactL �A4SESS: ALTH
CTCY: sla"�Aon STATE: w4 ZIP: Qy CYO STATE: ZIP:PHONE 01: '3100 1L10��4a\ CELL:PHONE N2:EMAIL tyT �t N M Y c . C•Wa EXP._/PRIMARY CONTACT0 OWNER COOTBPxJ�
NAME— 0.� EMAIL LK\.4m 1t, ��i. aT"
MAILING ADDRESS CITY B N-a STATE 1� ZIP 'S!C rb
PHONE 'Assa yG.ti CELL
PARCEL INFORMATION:
PARCELN[R.IBER(12 Digit Number) d\3036c�_-15 -oWaa ZONING
LEGAL DESCRIPTION(Abbreviated)Tt.� WA1C \ �`A\a'.�V1 FIRE DISTRICT
SITEADDRESS \ \ W am.CsC " y. W 4� CITY 6�W�a:3l�
DI RE DNS Tqq SITE ADDRESS
CCeS V a\\.�V '�T 0� `..: Y Yr�4CKAP� �xr \ %0A4 h
LSTWPROIECTWIT®H300117OFSLOPE(S)GREATIM1 B 14%: YESD N04 SNOW LOAD:�Y
j Di PROPERR[] L 1N200 FT OF TIIE FOLLOWND ] A'ETL&NDly):
SALTWATER❑ IAICE❑ RIVER/CRPEIC❑ POND[] WETLAND❑ SEASONAL RUNOFF❑ STREAM[]
TYPE OF WORK: NEW jg ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(nuumre.,,Umemam.M,BN%60 0 Ab J
ISUSE: PRIMARY SEASONAL NUMBER OF BEDROOMS I NUMBER OF BATHROOMS
HEATEDSTRUCTUAE? YES(whde R&WO YESlP.n(e),,,w40U NO[]
DESCRIBE WORK
&011ARF.FOOTAGE,On, ,sa) kcY
IST FLOOR�_aq.R 2ND FLOOA 11 1 cq.ft 31UDFLOOR_aq.ft. EASEMENT_sq.&
OECK_sq.R. COVEREDDECK 300 K.ft STORAGE sq.R OTHER eq.kvaw"
GARAGE eq.ft Anachad❑ De.oh [) CARPORT S190 K.ft Attached N Daached❑
MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLOOR PLAN REQUIRED'
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER y
NVIRONMF.NTAL HEALTH I-Fb tVL
SEWAOFISEWERSOURCE: SEPTIC SRWER❑ / NEWg( EXISTING[I
PLUMBING IN STRUCTURE? YES)g NO❑ 17fy ,amch comahmed Water Adepaary Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YEs)I NO[] EX[TDNGSQ.FT.
EXISTINGBEDROOMS R— PROPOSED BEDROOMS I TOTALBEDROOMS-1—
OWNER xkncwb6ge IMI suEmisson as Inecarele Inlamelbn may meNl In a slap aam draw d,pemtll nwution,....eEgemerrt plautll la Ey
signature beWw,I dedam tW I am On awnea and I Nal,er declam mat I am entand to receive IM1is p -4 antl In do IM1e-ak as proposed,I M1ave
reobpm m pd ,m p mLwsna ll N at i,is mreynn p NdIWis nY9 anye aasetlmmeanstohs om palopeaeNeINsoM forinlaer eGsl p,y Ol UsN Ko pNea bve dovmmew plmegael
Y
udispoct"(s)forrenexandinspeGm. IM1isgamNepplidabon becwna null&votl HxwkoraNMze] mm[wcrameneMxNln 180
tlays w X wnahuctionwA K fuspendetl tar a penotl of t W Jays.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERM APE CATION OF DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.00A2) P'T�
SignatureplOWNER Beal n
DEPARTMENTAL REVIEW APPROVED DATE' - DENIED DATE TAGSR40TEWCONDITIONS-.
BUILDING DEPARTMENT
( PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH 3
MASON COUNTY COMMUNITY SERVICES Permit No:l'/L�_Od/ 97
PERMIT ASSISTANCE CENTER:
•BUILDING •PLANNING •FIRE MARSHAL
615 W.Alder St-Shelton,WA 98584 RECEIVED ENVIRONMENTAL
www.co.mason.wa.us
Phone Shelton:(360)427-9670 ext. 352• Fax:(360)4290) 79#8 C�21 HEALTH
Phone Belfalr(360)275-0467• Phone Elma:(360)482-
PLUMBING & MECHANICAL PERMrP P4PPOCRMDN
OWNER INFORMATIOIN: CONTRACTOR INFORMATION:
NAME: CaC\ ciao. NAME:
MAII.ING ADDRESS: Q D Osl \qS MAILING ADDRESS:
CITY: CITY: STATE: ZIP:
1"PHONE: 3LPb-"�$ls - tiq�T PHONE: CELL:
2°a PHONE: EMAIL:
EMAIL: 0 �c\a a& �4 a�0a C om L&I REG# EXP.
PARCEL INFORMATION:
PARCEL NUMBER(12 DigirNamba'): o -�J 'oV Oa'� Zoning:
LEGAL DESCRIPTION(ebbr 4ated): l'Q'� o cV e!l a\I avkp -aw
SITE ADDRESS: la 1 W Mae v tc W 4•\ CITY: M CAS oN%
DIRECTIONS TO SITE ADDRESS:
C�oa a\\oa (LZ \ ar, a mupKtcl �cr Q t 1 S: c or L
TYPE OF JOB:
NEW_,\r ADD_ALT REPAIR_OTHER USE OF BUILDING
-
LOCATION OF FLYTURHSAJbHS-I-FLOOR_2-FLOOR.—BASEMENT GARAGE OTHER_
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
Twe ofFixlure No.of Fixtures Fees Fuel Type:Electric)t_LPG Natural Gas—Ductless X
Toilets a Tvoe of Unit No of Units Fees
Bathroom Sink 7 Furn80B
Bath Tubs a' Heat Pump .ems
Showers 'O Spot Vent Fan _
Water Heater 1 Propane Tank
Clothes Washer 1 Gas Outlets
Kitchen Sinks 1 Wood/Gas/PeUct Stove
Dishwasher - 1 Kitchen Exhaust Hood i
Hose bibs .A' Dryer Vent I
other Solar Panel
Other
Base Fee Base Fee r
TOTAL PLUMBING TOTAL MECHANICAL
OWNER acknowledge 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,owners legal representative,or contractor.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 authorized agent represents that the information provided is accurate and grants employees of
Mason County access to the above described property and Slruclure(s)for review and inspection.This permillapplication becomes null&void
0 work or aulhodzed construction is not commenced within 180 days or if construction work is suspended for a period of 180 days.PROOF
OF CONTINUATION OFTHIS PERMIT IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS
WILL INVN IEIIiTF-„THE APPLIC TION.
X c �-as -aaa �
Signature Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FILE MARSHAL
Rev:1/27/2016 1BN
P
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