HomeMy WebLinkAboutBLD2022-01508 - BLD CD Environmental Health Review - 12/6/2022 •
P,k 1Ott-0150$ -
0ss```''rL'•+t;� MASON COUNTY COMMUNITY SERVICES Permit No:
PERMIT ASSISTANCE CENTER:
•
rx •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL 1• '0 615 W.Alder Street,Shelton,WA 98584
f ' Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
Ii• ^yy Belfair(360)275-4467•Phone Elma:(360)482-5269
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BUILDING PERMIT APPLICATION 6/,. • ,ci
PROPERTY OWNER INFORMATIO j: CONTRACTOR INFORMATION: 4 . -
NAME: I(c i. `. S t id fr i . LA� NAME:� � C�S jvr'r \'Yle-S C` 1
CMAIL GAD SS: STATE: ZIP: MACIT AD S. STATE: ZIP: )A..);)��
PHONE#1: - (dl-I4— () PHONE: - ' CELL:
PHONE 2: EMAIL. t t iti -S ; C c.tr)—)
E _ [U4•1-5pi'le- t -S•C V yin L&I REG# ` E . /_/_
PRIMAR CON ACT: - OWNER 0 CONTRACTOR'' OT ER _ j,
NAME GL-V EMAIL P C ocnd,t;� O r—
MAILING AD R e L 1 TATE ,A. ZIP ] -7,5
PHONE - L-- CELL
PARCEL INFORMATION: /�
PARCEL NUMBER(12 Digit Number)`3?,3 -7�•"I t) , ZONING k, FJ� `�
LEGAL DESCRIPTION(Ab reviated) 1C/C- 31i I,'h .!, M i C It ' FI DISTRICT ,tir v1/ t„1
SITE ADDRESS 't' 1i h r OVl I-1L i k PI Xi• CITY h I Th I _ A
DIRECTIONS TO SITE ADDRESS fy �i•�
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESK NO 0 SNOW LOAD: psf
4/ /
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW/ADDITION 0 ALTLEERAATI ❑ REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence.Garage,Commercial Bldg.Etc) t JI-
IS USE: PRIMARY 0 SEASONAL 0 UMBER OF BEDROOMS 3 NUMBER OF BATHROOMS I.
HEATED STRUCTU YES(Whole Bldg),tty,/YES(Part/sf ottldgl Q O
DESCRIBE WORK OM M(� Yt.-E-c.„..)
SQUARE FOOTAGE:(proposed) /, /
1ST FLOOR I- lq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK .ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHERS sq.ft.GA�`���
GARAG - sq.ft. Attached Cached❑ CARPORT sq.ft. Attached❑ Detached❑ I rav
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
i MAKE YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: cS W� 2 I 5 f�' c�
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEW❑ EXISTING ----
PLUMBING IN STRUCTURE? YES NO 0 Ij es,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES �'`r()❑ EXISTING SQ.FT.
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 I am the owner and I further declare that 1 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 8 void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days.
PROD F CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
P M T APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
/ C COUNTY CODE 14.08.42)
X / 4( �L- / 2 2 9—
ignatt�of OWNER(Must be s ned by the OWNER) ate
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL •
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P • PO BOX 121 ono..-.1. �s` Q TROY AND SANDRA PETRICH GRADING AND DRAINAGE PLAN
wultR,ru sa»o c 121 E UNION HEIGHTS PL N PETRICH SINGLE FAA,LY RESDENCE
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