HomeMy WebLinkAboutBLD2022-01536 - BLD CD Environmental Health Review - 12/13/2022 �eo4 cooNr} MASON COUNTY COMMUNITY SERVICES Permit No: "LLLQaOaa� ()Is-ND
4 - PERMIT ASSISTANCE CENTER: R ``-
> .BUILDING•615 W.ING•Alder S��C ShelIJC ton,WA 98584 RE MARSHAL 1 \E C E 1 V'L�V
�� Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
Beltair:(360)275-4467•Phone Elma:(360)482-5269 DEC 1 3 2022
I85Q ENVIRONMENTAL
BUILDING PERMIT APPLIC T�I� AkiAr Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: H EA LT H
NAME:% d(.001 ->//0/. NAME: Ile_ t l/!UCL1a 1
MAILING ADD ESS:jf_/A t rA,e ra. MAILIN ADDRES : s ;• .4....
/,'
CITY:de l/M4 STATE:K/4 ZIP:Lj_�'_�LC�' CITY• STATE:fv ZIP: �SrZQ `\�
PHONE#1: 7 -/ e.CG9 7/76:7 PHONE: ELL: -�(
PHONE#2: EMAIL: a .rto ai \ ,%Y.G
EMAIL: AS fie%lN4<i/. erg.i L&I REG#recd..;G#�y ^f -EXP.-Z/7/_,Zie
PRIMARY CONTAC // OWNER 0 CONTRACTOR❑ OTHER❑
NAM�weir/ �fy�� r EMAIL ,.LS, /l,�/Y•,,,,
MAILING ADDRESS z-/�� E�r�LIl-Gr �•< CITY Y.� ij STATn.2.1.¢ZIP 9,f4.1Pl
PHONE '7O/ .Zacci 7/7 4e, CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) Lo32-/-T-6:/ e ZO G .1V--eiy Y1/SC/
LEGAL DESCRIPTION(Abbreviated) CT '7
SITE ADDRESS CITY
DDIECTIONS TO SITE ADDRESS i
-�i, L'a--/in&..c D / r e o i L
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO I�
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[i ADDITION❑ ALTERATION❑ REPAIR❑l OTHER ❑
USE OF STRUCTURE(Residence,Garage.Commercial Bldg,Etc.) 6A'J"`L5iL/s�Otel
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE?`14 AYEES(Whole Bldg)g YES(Part[s]of Bldg)❑ NO❑
DESCRIBE WORK "0a 177 tleX13 i •L1 ' .41Ae-10-,`/ s eil G-Vj
SQUARE FOOTAGE:(propose+existing)
1ST FLOOF '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.
GARAGEIt4)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 SEWER 0 / NEW 0 EXISTIN%,
PLUMBING IN STRUCTURE? YES❑ NOee If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOg EXISTING SQ. .
EXISTING BEDROOMS �i PROPOSED BEDROOMS cd c 7
TOTAL BEDROOMS C,
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 permlt/application becomes null 8 void it 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 D YS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
c COUNTY CODE 14.08.42)
X /et-/// 4 a
Signature of OWNER u be st e OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL , _1 (J,
PUBLIC HEALTH \)ci,�� C.V`eJ\h O�)6, k'XL-f1'
molitimillr , _
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oer• 7r1 en,/
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_ EH APPROVED _
...4 Rhonda Thompson 01/09/2023 (3(-5.-b ,g
-:-.44.'—
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.._.2r#4.1^ i EH Setbacks -•
And Emil
L„.. mil i AB...)))sNDeorpat iincf iteatVnkR)sery foundation/perimetere requiresre i u5!rsees Drains al Oc'setback tthrboaimnc 3kaolti rttornd ofooting/foundationswng tooling/foundationsradient of
_ - •-- - — _
—
1.11 Drainfield/Reserve area
D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within
— —_-_-_-- - 50ft,down gradient of Drainfield/Reserve area
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