HomeMy WebLinkAboutBLD2022-01415 - BLD CD Environmental Health Review - 11/3/2022 ` '''kl t. MASON COUNTY COMMUNITY SERVICES Permit No: �jlc�2 7Z- 014 ID
c. PERMIT ASSISTANCE CENTER:
"t •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL J
t$ 615 W.Alder Street,Shelton,WA 98584
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t ..t- Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
�- .4,4• RFC ia—
y Belfair(360)275-4467•Phone Elma:(360)482-5269
BUILDING PERMIT APPLICATION /k
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: A'
NAME: 6.01 ')tA 2 NAME: 67 N�vO �O
MAILING ADDRESS: /6// / Pi Kau A 1Q., �MAILING ADDRESS:...... .----- - ..- . --- ._.`s II/ �42?
CITY:APHONE# : f STATE: ( ZIP: PHONE:CITY: STATE:
CELL: ZIP: 'q/ay
PHONE#2: 3 -
y7a• EMAIL: Strock
EMAIL: 4I4^ Q • C�tf L&I REG# EXP._/ / —et
PRIMARY CONTACT: t{ OWNER' CONTRACTOR❑ OTHER❑
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP �/'��
,�R/�
PHONE CELL 16a 'i7D 9952 A '
PARCEL INFORMATION: T
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PARCEL NUMBER(12 Digit Number) 9/ /27 33 0OO Ii 0 ZONING /l Q �k fly /1 k
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
+
SITE ADDRESS I/44 & .C-644- trial /Q r _CITY Sits OVA
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NOA SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND 0 WETLAND,' SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEWS' ADDITION 0 ALTERATION 0 REPAIR JJ OTHER ❑Z
USE OF STRUCTURE(Residence.Garage.Commercial Bldg,Etc.) 1O It &OW La 1 t tt �r`Ti61.Gt/�
IS USE: PRIMARY X71 SEASONAL 0 NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2----
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Parris]ofBldg)X NO 0
DESCRIBE WORK /✓ l CONS te.VG M,.
SQUARE FOOTAGE: (proposed)
1ST FLOOR i)3 I ,sq.ft. 2ND FLOOR 511 7 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK 35q sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE 2S 25 sq.ft. Attached 0 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: Sti ZoZ2 —COO 77
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEW. EXISTING❑
PLUMBING IN STRUCTURE? YES$' NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
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
PER APPLI 1 elf F 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X 9
///' /wz _
na a of 0 E(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH W "k (7,3 Lc .ctd-‘, GCS. k
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