HomeMy WebLinkAboutBLD2021-01275 - BLD CD Environmental Health Review - 8/16/2021 (2) L... •
MASON COUNTY COMMUNITY SERVICES (It Permit No:
' PERMIT ASSISTANCE CENTER: R E C E
! BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL /'_'''}�,
615 W.Alder Street,Shelton,WA 98584 '�• 1 i t� a i ,'i 1 TA
f" Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone AUG
\ y.* Bel/a r(360)275 4467•Phone Elora:(360)482-5269 6 2021 HEAL, ,
BUILDING PERMIT APPLIWW1 Alder S re. •t
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: lJ ` '
NAME: 1J gp•n0 J gr-w E i/ NAME: , . Ce)(1 6
MAILING ADDRESS: // I 4 g_Ait.ga AA /W i MAILING ADDRESS: C A Alt
CITY:S/al..-teJ STATE: wA ZIP:98s'/ CITY: "SfA3TE: ZIP:
PHONE#1: 3 Goo-83 a -- VGA? _ PHONE: CELL:
PHONE#2: EMAIL:
EMAIL:V 1..)TA G.a t4A•vdY fit•A+a 6 de d.0.6 G FotM L&I REG# .I trPTA HS 0411 c.0 EXP. sr/7 /'; . .
PRIMARY CONTACT: OWNER[ CONTRACTOR❑ OTHER❑
NAME 4.4 EA 0 \I e LA,E'77 EMAIL
MAILING ADDRESS t/t ' x/f C R OA ✓�-A A CITY S Ntf L7eh) STATE t.uA ZIP Fez-S Si
PHONE 3Go-CSSO•- 29 CELL
PARCEL INFORMATION: ` 27 -C() I1
PARCEL NUMBER(12 Digit Number) — ZONING /ZE S I P t nr n AL
LF1iAL DESCRIPTION(Abbreviated) FIRE DISTRICT 4 5-
SITE ADDRESS D E G LA1K(S C j CITY 3 HE L:Ar-J --
DIRECTIONS TO SITE ADDRESS 14(...../V 3 To re ASo^4 C.V.. gts we I s'r L.tL t wvNktZtc4.-
F-,..7rnA.)C F_ ON f;L% t PRST .GC...9LI t}o.r ro Crc+.,ru S C.1
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO[SNOW LOAD:___psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE Er RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE dents,Garage,Commercial Bldg Etc.) IC-I l O e NC e
IS USE: PRIMARY]SEASONAL❑ NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)[YES(Part[r]ofBldg)❑ NO❑
DESCRIBE WORK ize-/ -'�/atA._ 6t=(44 a,. L-AI(..E S,s E or' N-c' E
SOUARE FOOTAGE: (proposed)
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK-]c] Z. sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEI. YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC Fr SEWER❑ / NEW❑ EXISTING `
PLUMBING IN STRUCTURE? YES❑ NO If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOEr EXISTING SQ.FT.
EXISTING BEDROOMS '' PROPOSED BEDROOMS dia. 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 on 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.
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 / g.-14,-.20:2/
Sign tur f OWNER(Must be signed bvshe OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL _�
PUBLIC HEALTH ��((NI C I ) cqS-cSic.2,1
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. Alder Ji� 2t
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APPROVED
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AUG 11 2022
t MASON COUNTY ENRETVIRONMENTAL HEALTH _
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ENVIRONMENTAL �t-Ola`ls RECEIVED
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MASON COUNTY ENVIRONMENTAL HEALTH
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