HomeMy WebLinkAboutBLD2022-01528 - BLD CD Environmental Health Review - 12/12/2022 12
: MASON COUNTY COMMUNITY SERVICES Permit No: P.\ 21o2 O IS2U
• PERMIT ASSISTANCE CENTER:
I
.BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL /�
.I p 615 W.Alder Street,Shelton,WA 98584 /-�
,�.....�' Phone Shelton:(360)427-9670 exL 352•Fax(360)427-7798 Phone
1;',.
~'l-0$' Belfair(360)275-4467•Phone Elms:(360)482-5269 . )_I �, /�
tiS.ru rid.' / k. V
BUILDING PERMIT APPLICATION tPr-
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: 6 /,rj I 2 er,';")
NAME: L ear SOS Q NAME: '`%,r cm
MAILING ADD SS: .O Q�.r at IK k MAILING ADDRESS: //�� i
CITY:sh 411 STATE:%kik IP:Sc,S11 CITY: STATE: ZIPS rt
PHONE#1:_'3k-L)' 1-1Q'CLit)(k PHONE: CELL: /7i9(�
PHONE#2: EMAIL:
EMAIL:jai s�-E'v%P�51 ( G ima;1,C..Cfl L&I REG# EXP._/ ��.•.-'^
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER 1 r/l� �7.
NAME �� '� r�e� EMAIL r I,C�S (���'mtl l 1 C Vl .7
MAILING ADDRESS2,OvC +A-- R4 CITY a..t •'• STATE tC..♦ ZIP
PHONE CELL 'b ' 3`jQ k C1 66 Ili
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) .3&0 1 l I I 0 00 1 0 ZONING ik.`.c.J
LEGAL DESCRIPTION(Abbreviated) 1 • FIRE DIST CT 5
SITE ADDRESS CITY G
DIRECTIONS TO SITE ADDRESS ` ` ,
•
4 ,r . k
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO.K.SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW' ADDITION 0 ALTERATION 0`` REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) RECxe e,,, C cia 0,..\
IS USE: PRIMARY❑ SEASONAL r'` NUMBER OF BEDROOMS C NUMBER OF BATHROOMS 1,
HEATED STRUCTURE? YES(Whole Biddg)% YES(Parr(sJojBldg)0 NO149
DESCRIBE WORK PA i1& 21p 5%; t_ &<cL{L%ce_
SQUARE FOOTAGE:(proposed)
1ST FLOOR h i 0 sq.ft. 2ND FLOOR C) sq.ft. 3RD FLOOR 0 sq.ft. BASEMENT 0 sq.ft.
DECK C) sq.ft. COVERED DECK `, sq.ft. STORAGE () sq.ft. OTHER 0 sq.ft.
GARAGE () sq.ft. Attached❑ Detached❑ CARPORT p sq.ft. Attached❑ Detached D
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BA SERIAL NUMBER
ENVIRONMENTAL HEALTH: IAleI2All" 06031 , Ap,A20Vi -pQ°41
SEWAGE/SEWER SOURCE: SEPTIC.CKSEWER❑ / NEW 0 EXISTING
PLUMBING IN STRUCTURE? YESX NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOO EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 0 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 permiVapplication 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 \I -� ) 0v -2:Z..-
Signature of OWNER(Must be signed a OWNER) Date
i
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL � 6 �(,
PUBLIC HEALTH \I"\ Z� Cj'Y `' '4�'�cgj�'s"`�i
4,.,aa.,•„w
iqiiqi
a 7i 1A a�� 3p�a '#A All 3l f s��. ': � a €g , E0 �p Jell €il 11:2111 li 11 ij 0 Ili.II!111E 11' a $R lli Ixffi
{g k agag 915,10 8
, 10 11 t illirgli Ilan 41 lii IR " .
11
Ai0
•
Ci—
.__ ,Sihvi 81 ii 0111 ,„ !
! MI- - .._._.i ', N m
ip i
. E N 87'00'00"W
•
'� QN /--- '95.25' — '
cp
---141 i I f 1 ; .e f o o /
I
f ''1 ° fzf
/
it if 1, o
=s. ;� ( a /
r �� 6 j....;...� . , a
1 4� /
. .�, A\I {!0®i '
f _ 12'. i f - 1 f•f 0
/ 1 K>
! I it Fdp.
0 11 j 42.-4,, a
1 ,,
. ,
A r
• / o 15
I
a p__ v,
Pil co,„
ii n If ' - Itc
m / .o'A /
48
4 / f'`"--.1
IV I / .ram
Ca /
go �� r B
S.
Im F g / \ i
1 a ol,a` _ g) / 0 \. I 3
co
4 d i 5 1 �
$ gg O / / A 1 H
11
I f -+se.oe I
$ Q�y ! A.oya
C!�`g L-- — — NEW 34'3r W
'--- — -1
o — \ / I
• PROJECT:
D 1 gg s w f ,i LESTER BAILEY •• LJB DESIGNS, LLC
,O 4 9 n y 2080 EAST AGATE ROAD 1.1111031. "p:�,.wmIC
111 Mtk.I Sena N.E.,Sails]1J
3 e p •
SHELTON,WA 98584 a,a„G m O W "?>MI
i m p 'a"01.191 u1ANUa w1..... 3CO)t6•..1945
R PROJECT V,sa...... STATUS: i