HomeMy WebLinkAboutBLD2022-00676 - BLD Application - 5/27/2022 s -n „w MASON COUNTY COMMUNITY SERVICES ; �'� `�—/'y��j`�
• - '"' PERMIT ASSISTANCE CENTER Permit No: v i `fl1 ca
I �. . ) ...BUILDING.PLANNING.PUBLIC HEALTH•FIRE MARSHAL
1 615W.Alder Street,Shelton,WA 98584
Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone
K.,,,
.„ // Belfair.(360)275-4467•Phone Elma:(360)482-5269
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION:` ' CONTRACTOR INFORMATION: ` / v 4. �-"y
NAME: P V<• Le u W Y�-1�1 fit NAME: -u i/Y 1�i Y ; tJ-e
MAILING ADDRESS:1,3 60 Cr /4u OA(.-P. 6kS MAILING AD RESS: 6.t f /9 22
CITY:G rAPCt11 ff IA'STATE: V`1. ZIP: 4 �;f 4 CITY: STATE: ' -EI$+/ t
PHONE#1: 3(90- 1-0) - ' G0N PHONE: CELL: 'ldc,
PHONE#2: 0 40 - 2(� - 3 4,3 0 EMAIL: •�tI
EMAIL: h 0 tv,(V.S4 nit .59' t°$titOa . A. L&I REG# EXP. / / het
PRIMARY CONTACT: OWNER r-VCONTRACTOR❑ OTHER❑ /t
NAME r";.` EMAIL
MAILING ADDRESS I CITY STATE ZIP ` 04
PHONE CELL
PARCEL INFORMATION: I /7'4* t Ck7kAi1. /
PARCEL NUMBER(12 Digit Number) Z 1 1 v 7 J pa(1 ZONING - L4 i y
LEGAL DESCRIPTION(Abbreviated)��.,3 o 5 P. A'I I3 I tI a2 S5- FIRE DISTRICT
SITE ADDRESS n t �- CITY jr'J 10 1
DIRECTIONS TO SITE ADDRESS M4SDn L G p.J `t'G? 1^0SAI,.413-01So f /AV kat 7 oex 5&NI/t
1 L'1="T Dn f470S (4.. ) 12,11 Kt 144rti? .Si l,+t! 45* Ent) tr (J ( t -
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) 5'fi?it itir 44-"'"
IS USE: PRIMARY❑ SEASONAL D NUMBER OF BEDROOMS -.4 NUMBER OF BATHROOMS lf:7'"
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Part[s)ofBldg)❑ NO❑
DESCRIBE WORK Vt) k le /'71 Cale 6 q)C„P j/1
SQUARE FOOTAGE: (propose+existing) 3 ( (,s
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft Attached❑ Detached❑
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 .7^ ' / NEW V EXISTING❑
PLUMBING IN STRUCTURE? YES NO Ur Ifyes,attach completed WaterAdequacy Form
PERIMETER/FOUNDATION DRAINS PROPOS 11. YES❑ NOB,'" EXISTING SQ.FT.
EXISTING BEDROOMS -6`- PROPOSED BEDROOMS .4.--_7 TOTAL BEDROOMS i."' '-M
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 fora period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APP) CATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X �",� • / 3 )2-�
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES✓CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL PUBLIC HEALTH b(o1L1-4 (U4 t 1 1 1(✓ItiS- QQUA p
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/ (-1) Audio-Visual Alarm. *223 04-19— 660g0 .
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/ (72) Cleanout
500 Gallon Pre-Trash tank et4 LOC)
0)1,4 04;fit,..10.,
/
(3 NuWater BNR-500 ATU Tank
0 I. 000 Gallon Pump Chamber
Arrow Septic Designs
/ (3 Valve Control Box ¶71 E.Weeteit Ot
Unitifts WA 24592
(360)898-2255
EH S9tbacks 0)6250,-00 C.)710
A.) DrainfieldiReserve requirefl 0 setback from footing/foundations
B.)Septic tank(s)requires 5'setback from all footing/foundations
C.)No foundation/Perimeter Drains within 30ft,downgradient of EH APPROVED
DrainfieldiReserve area
D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within Rhonda Thompson 0630/2022
50ft.down gradient of Drainfield/Reserve area