HomeMy WebLinkAboutBLD2022-00470 - BLD Application - 4/15/2022 •
„:.�" f4:i., MASON COUNTY COMMUNITY SERVICES Permit No: G V'G D
PERMIT ASSISTANCE CENTER:
�� .BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
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615 W.Alder Street,Shelton,WA 98584
:— %--�;s.- APR 15 2022
t � ,,. Phone Shelton:(360)427-9570 ext.352•Fax:(360)427-7798 Phone
'3i Belfaic(360)275-4467.Phone Elma:(360)482-5269
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BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION:/1 CONTRACTOR INFORMATION:
.J NAME: GU/C� ' ( UCCIPtc NAME:
Q MAILING ADDRESS: It / E./ ,2 2,/ I.v, MAILING ADDRESS:
r7'` CITY: 57)f/t1r,n STATE: L e,V4Z 5£3 e./ CITY: STATE: ZIP: -
Z PHONE#1:360 `333 -0/76, PHONE: CELL:
= PHONE#2:3 re • 2.. '"2h0 EMAIL:
EMAIL: A/rri P./iim Qiro/mar y. C c-rM L&I REG# EXP. / /
PRIMARY CONTACT:�/ OWNER❑ CONTRACTOR❑ OTHER,
z Q NAME ,7�,-).: /�e/an y EMAIL
(D LU MAILING ADDRESS .24'2-9 S('hi'✓m L Ed , U) CITY Ul "&
•u' STATE - ZIP`/�S '2.
M = PHONE 3e,0 — Zg "24.4.'0 CELL S''72c _ y
PARCEL INFORMATION: I '
Z PARCEL NUMBER(12 Digit Number) .a2`7 � L..- oo 13 ZONING r ► 5
Lu LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT 5
SITE ADDRESS Ir4/ e. IiZZcf Liri CITY She/1z17
DIRECTIONS TO SITE ADDRESS A-1 e C / d •fry L. c.rrr C . f 1c..: f-er R. Un
4/zzy La„-e
IS THE PROJECT WITHIN300 FT OF SLOPE(S)GREATER THAN 14%: YES NO SNOW LOAD:25psf
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,Sic)
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)❑ S(Pert(s)ofBldg)0 l SO
❑ 1 L _
DESCRIBE WORK lam► et r� 0 T US e. -1 CDO "II) tei �J p ace
SQUARE FOOTAGE:(proposed)
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1ST FLOOR 14 C Z.J 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❑ ,`
i
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN MID*
MA MODEL LENGTH
DTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTING(
PLUMBING IN STRUCTURE? YES NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION//D'�RRAINS PROPOSED? YES❑ NOZ' EXISTING SQ.FT.
EXISTING BEDROOMS V PROPOSED BEDROOMS I TOTAL BEDROOMS I
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 for a period of 180 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 APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X , „e174.. — 15- 2022_Signature of OWNER Mu caned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE . DENIED. DATE TAGS/NOTES/CONDIfIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL �j .�
PUBLIC HEALTH ! (GIVI h'L Z'Y ad()_,
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POS51 BLE EH APPROVED 1
Rhonda Thompson ffi%24r2022
1
l WATERLINE 1
1 f •1 H i . p,
1 w EH Setbacks �` w^ `
A.)UramteldReserve requires 10'setback from tootingrtoundanons '� 1
1 0 j Septic taiikl,sl requires 5'setback from all lootinryfoundatmns
LL.I CD 1,No fountlaaoNPenmotor Urains within 30't.downgradiant of
UrainlieldrReserve area . f
IDI Nc Cut Bankfs�(groetar than 5tt and over 45 dagreast within + 5,0051
1 SOft,down gradient of Drainfield'Reserve area R. ERT r1 `/SSE
I I 77Y%(l:i :i.ji�
I `0 I Etiiis 3
Z PROPOSED 1
g 1 A 4 BEDROOM 1us:
I N 1 PR 0 V DRAI•'-.: •
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1 Ark I
MASON cQUNT ZU1J w f
SNviR�NMENTgt H o.
I I BpiHEALTH 0
1 1 1; 1
I POSS BLE FUTURE `V
1 DR(V WAY r1iI1I
< 1 RESERVE
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1 TANKS ,,,, �,%i
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CURRT ACCESS
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INSTALLATION DESIGNER SIGNOFF/ASBVILT FEE WILL
BE CHARGED AT TIME OF INSTALLATION
T CUSTOMER: DAVE COCC-U SCALE 1:40 1
PIONEER DILzLxIN', IN r PARCEL#:32024-22-90013 ADDRESS: 141 E UZZY LANE
rot TEST HOLE I: TEST HOLE 2:
0-18 SI LOAM 0-18 SI LOAM
SEPTIC DESIGNS 18+MOTE 18+MOTT.
P n e E �' f`J* fZAPEVIEW,W13 5 5 !• b OFPAYSSE R 18 R 18
Nrinted from Mason County DMS