HomeMy WebLinkAboutBLD2022-00806 - BLD Application - 6/23/2022 ,!i `''"t., :;.� MASON COUNTY COMMUNITY SERVICES Permit No: C �t �
\. PERMIT ASSISTANCE CENTER:
nY ..BUILDING.PLANNING.PUBLIC HEALTH.FIRE MARSHAL
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I 3 615 W.Alder Street,Sheltwy WA98584 i li„r•f`+
- s",- -., Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone `^••�
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BUILDING Betfatr.(380)275-4467•Phone Efma:(360)482-5289 f � L)
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PERMIT APPLICATION 6 7 "3 2191,
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: ' . i/
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NAME:C 1>,+t t.. NAME: Y(t iV L7 vs 14 () V?'1 �r S�J
MAILING ADD SS; il.._4tr ek Lft MAILING ADDRESS/Qi, sr 5-yoz, e�'t
CITY: STATE:_ZIP:di s CITY 1 s;(-i y STATE:Li i P- ZIP",_rt S(:ri
PHONE#I: 34p.&My.13244 PHONE;3 c 7-2i,TthCELL:.;I: 3
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PHONE#2: EMAIL; cr c-:,.K! .,"L.L J) '1:`^-e'.\1-(Z.) '"
EMAIL:444,"r 42.it 40 t tprll t g.{41A L&I REG# 7.
PRIMARY CONTAC• OWNER❑ CONTRACTOR,/ OTHER❑
NAME _�4'Ejfiti t EMAIL
MAILING ADDRESS T ' .. t)?( Smoot) CITY;C.c-t 7 STATEt ?i- ZI'(A:.. "'Y
.._PHONE 3i+ 1!Z.—�l t 3`� CELL i�0
PARCEL INFORMATION: /�
PARCEL NUMBER(12 Digit Number) 72r(7 —S( -1701CCI:.: -- ZONING N 'CA"7�/
LEGAL DESCRIPTION(Abbreviated){� I FIRE DISTRICT:. `r�
SITE ADDRESS 7 9 1 dL t,!i� `r.,L--,p CITY S:h.\\-Ci ifl
DIRECTIONST SITE ADDRESS •$,'y11a--VsD-s. (c,\�o-, r 1�t �. (t; j 1•,,;,-a-- p!"
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Sc, .r.t,'..X.., 1 c rn.. 4U(' C6„\ <,()Cr\< 1_c.), C>,
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%; YES❑ NO(SNOW LOAD:f
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all rhar apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW V ADDITION❑ ALTERATION❑ REPAIR❑ OTHER 0
USE OF STRUCTURE,(Reiideece,Garage,Commercial Bldg,Eta.)
IS USE: PRIMARY[/SEASONAL❑ CUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(tvhaleBldg) YES(ParrlajovBldJ❑ NO❑
DESCRIBE WORK ,k3 v Css...; M ............._
,SQUARE FOOTAGE:(prepared)
1ST FLOOR I,5-1 2 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.R BASEMENT sq.ft.
DECK /La sq.ft. COVERED DECK sq.R STORAGE sq.ft. OTHER sq.ft
. GARAGE sq.ft. Attached❑ Detached 0 CARPORT sq.ft. Attached❑ Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE (J.4e4 +�ij tibsc.. MODEL j ret.ZG,' 's YEAR. 14122.2. LENGTH 610
1
WIDTH 2.8 s BEDROOtv1S 3 BATHS Z SERIAL NUMBER 7.4Q
ENVIRONMENTAL HEALTH: i.
SEWAGE/SEWER SOURCE: SEPTIC SEWER / NEW EXISTING
PLUMBING IN STRUCTURE? YES NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOW EXISTING SQ,FI'._ I.
EXISTING BEDROOMS _ PROPOSED BEDROOMS TOTAL 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 tam the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained pamrisalon from all the necessary parties,Inducting any easement holder or parties of interest regarding this proJecL 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 b void if work or authorized construction is not commenced within 180
days or If construction work is suspended for a period of 160 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION O 18 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
j644‘44 COUNTY CODE 14.08,42) {� 201
•
Signature of OWNE (Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH 11 11i
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LOA 9 Salvo � ` 07/11/2022
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EH SETBACKS
1rN'' i ' L}«'a f!c z w t,'F so B)SDepticl teal
dnkse)s equiress 5 rsetback from all f otes 10'setback from o g/foundat opts
ions
p inteki from,?{tS,rioi;cc: C)No foundation/perimeter drains within 30'down-gradient of drainfield/
reserve area
D)No cut(s),bank(s)(greater than 5'&over 45 degrees)within 50'
down-gradient of drainfield/reserve area