HomeMy WebLinkAboutBLD2022-00421 - BLD Application - 6/24/2022 `"=`rr
MASON COUNTY COMMUNITY SERVICES Permit No)laa 202Z•Obl-�'Z
PERMIT ASSISTANCE CENTER:
' •SUILD/NG.PLANNING.PUBUC HEHLTfI.r FIRE MARSHAL
{y 615 W.Alder Skeet,Shelton,WA 98584
'�` ` Y(. Phone Shelton:(360)427-9670 ext.352.Fax:(360)427-7798 Phone JUN
,_ / Wan:(360)275-4467•PhoneEfine:(360)482-5269 J U N 2 4 LU22
BUILDING PERMIT APPLICATION
615 W AIdP- Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: -W1 t C.h!j 1 . (KC r 1—,T1 S NAME: t)R. E_t as14;- f, r.
MAILINQ ADDRESS:6SI G`I"Ctif} _ t1'.
t r i f vC({ MAILING ADDRESS•-T-7Q7 ye„r'� re,' ;
CTTYb pi r-�-?` fAla _ STATE:'•P). ZIP. CI TY:6 Ivs 1'!G-r-bo I- STATE:itj .ZIP:gli S.
4 PHONE ni': . l 7- fry e �. 99 Z ' J
PHoNEto• PHONE: CELL2. a-tr t',.-Lti8
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EMAIi:1Y!1[�1{1�. EMAIL: c�( tab I r� a Iva,t; r'O�'Y,
nhb►nsti55`it j v*4��REG1/ert-aer.6tt� _TA E .L,L/2-1 Z
PRIMARY CONTACT:- OWNER❑ CONTRACTOR( s' OTHER 0 f� W =
NAME - oss R lc t3i/.'t- . EMAIL C Pe-rot(i;SI:YS.S"'3'9!J MAILING ADDRESS %-7cc7_y(_tl' Vr1,-e, -.N.4_ CITY&e'er 1=nrbt'±r err ,�E
PHONE ' CELL �3` to92n-4 G8 STATE fS)G . Z �?�r�
PARCEL INFORMATION: r O W
PARCEL NUMBER(12 Digit Number) ?1 ? ZZ—els a 7...07 ZONING i Lt t J„' t t�s, CC _
LEGAL DESCRIPTION(Abbreviated) rz•, -.c� Urn rn t=..-t ei, rJ,t.. Fa: t',4-�o,7 FIRE DISTRICT Sh ADDRESS '
SITI; ,� �';*n�
`J 1—b Col-d }r,t In C.t r CITY S N el+n ram, 9 a 552,4 Z
DIRECTIONS O SITE ADDRESS -I G k.- S; it+wi <lac, 6f.` I.e.-R-- . e. W
- R_ I2 elxn: Rome, Si v-, n 's�'3PSn4.
J Lr.c� . Cie- _i.., i ��, tic: t,,
IS flit PROJECT WITHIN 300 FT OFSLOPE(S)GREATER THAN I4%: Y ESD NO NOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check aft:het appl)�_,/
SALTWATER LAKE❑ RIVER/CREEK -'"POND❑ WETLAND I7, S.EASONAL RUNOFF ErSTREAM
TYPE OF WORD: NEW W.ADDITION 0 ALTERATION❑ REPAIR❑ OTHER 0
USE OF STRUCTURE(Restdetre.Garage,Corutcrcfid Olds,Etc, [ r s
IS USE: PRIMARY SolEASONAL D NUMBER OF BEDROOMS Z. NUMBER OF BATHROOMS 2.I12—
HEATED STRUCTURE? YES(Whole3ldg) YES(PeifsJojBldg)❑ NO 0
DESCRIBE WORD II iM, j
t) t?WI.a
SQUARE FOOTAGE:(proposed)
1ST FLOOR 574. sq.ft. 2ND FLOORI 2118 sq.ft 3RD FLOOR 32)sq.ft. BASEMENT sq.ft
DECK sq.ft_ COVERED D/EC^K. Sty sq.ft STORAGE sq.ft. OTHER s .ft
GARAGE 574 sq.ft. Attached Detached q
❑ CARPORT sq.ft: Attached❑ Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAK MODEL YEAR LENGTH
IDTH BEDROOMS BATHS ER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEW EXISIING
PLUMBING IN STRUCTURE? YES 0--"... NO 0 If yes.attach completed Water Adequacy Form
PERIIvt£TERIFOUNDATION DRAINS PROPOSED? YES[t'" NOD EXISTING SQ.FT_
EXISTING BEDROOMS PROPOSED BEDROOMS 2. TOTAL BEDROOMS b
OWNER acknowledges that submission of inaccurate infonnation may result in estop work order or permit revocation.Acknowledgement of such is by
signature below.I declare that I em the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I Pave
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 nut&void if work or authorized conctn•Ulan to net cammenccd within-too
days or it construction work is suspended fora period or Tao stays.
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 APPLICATION TO BE EXPIRED.(MASON
AANL*
COUNTY CODE 14.08.42)
Signature197177 R Must ZIL I•ned• the OWNER)
Date
DEPARTMENTAL REVIEW APPROVED DATE - DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH bNl it, Lam 1- ,s
. EH Setbacks
A.) Drainfield/Reserve requires 10'setback from footing/foundations
B.)Septic tank(s)requires 5'setback from all footing/foundations t t ter'
C.)No foundation/Perimeter Drains within 30ft,downgradient of Q ,.--✓"
Drainfield/Reserve area --
D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within
50ft,down gradient of Drainfield/Reserve area
1
EH APPROVED
Rhonda Thompson 06/28/2022 )
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