HomeMy WebLinkAboutBLD2022-01088 - BLD CD Environmental Health Review - 8/16/2022 -, --- MASON COUNTY COMMUNITY SERVI O5 VE -fl?Daa-01068
PERMIT ASSISTANCE CENTER: RE•
r' BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
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615 W.Alder Street.Shelton,WA 98584
•;: qi,;:i Phone Shelton:(360)427-9670 cxl.352•Fox:(360)427.7798 Phone ENVIRONMENTAL
Bollair:(360)275-4467•Phone Elma:(360)462.5269 615 •`dd q/.
n•' 1 Alder Street f^ ,_ HEALTH
u
BUILDING PERMIT APPLICATION '
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
l' NAME:__ ___ kt S I011U Ian NAME: �w-�-t re..., 1-4ern s
MAILING ADDRESS:; PE B 4 G.r1 LI:MAILING ADDRESS: 0,.L
CITY:1�7P.1� f STATE: t OAZIP! 1 CITY: 'ram • _STATE: _FLIP:
PHONE III: PHONE:3(.0.0_11a25H cgr,oa
PIIONE II2:_ EMAIL::ipl _
EMAIL: -----.-. L&I REG)7S• (42={X.)XP. / /
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a PRIMA Y CONTACT: OWNER CONTRACTOR OT TER
NAME V+ fit SKI rl(1 " ❑ EMAIL AM 4 ��' 5� �lY"J Rj (7/ /fe-rC,. COP
MAILING ADDRESS 4 4.5 i/ Q CITY STATE ZIP
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PHONE' �-/lO (D f8 t CELL — ---PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 3 3 2 -5 I - Ci oo o Z ZONING
LEGAL DESCRIPTION(Abbreviated) Lei 42 Oi 1'-6_ E-5-4-. *S -`_Ce -FIRE DISTRICT• _-
0 SITE ADDRESS 1(7 I 1J Er 13 l e+'I ( 17>' -_- CITY •6z-1•--r_i c-
DIRECTIONS TO SITE ADDRESS A.e.c.r,Ss . ,•••tit h ,mot be,/ I c r ti I--;I;r','✓.1 r..,n
IS TIIE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO p( SNOW LOAD:_psf
IS PROPERTY WITHIN 200 E'1'OF THE FOLLOWING: (C:hrrd-all that opplv): r
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW❑ ADDITION 0 ALTERATION❑ REPAIR 0 OTIIE\\R, . r.-�J)e-ic'.-Ire-n 1-
USE OF STRUCTURE(Rruvlrn e.Garage.Commercial Bldg.Lie.) I�tr c.el e rr C.t'._ 5 F' 11-/
1 __--
IS USE: PRIMARY[ SEASONAL❑ NUMBER OF BEDROOMS_ - N_• UMBEROF BATI(ROOMS ,_
HEATED STRUCTUR_E?? YES(throb• c)B/d Pi YES Werrfs)of 8/dg)0 NO❑
DESCRIBE WORK_ Demo N'Dispose of Flristing Mobil&Replace with New
9
SOUARE"FOOTAC EI-•, ,e,,,u
(IST FLOOR ley6o sq.ft. _.2AD FLOOR sq.R. 3RD FLOOR sq.R. BASEMENT sq.II.
`-D1;CK -sq.ft. COVERED DECK sq.II. STORAGE sq.ft. OTIIER sq.R.
GARAGE sq.R. Attached 0 Detached❑ CARPORT sq.R. Attached❑ Detached 0
D MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
0
MAKE .. u' (. -- MODEL _1 rsk S 5 co t f YEAR 20Y I LENGTH to?.--•I
WIDTII ,3(7 ! BEDROOMS BATHS c - SERIAL NUMBER_ I
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC> SEWER / NEW 0 EXISTINCL,a"
s
PLUMBING IN STRUCTURE? YES,' NO 0 liver.attach completed IVaterAdequacv Form
PERIMETER/FOINDATION RAINS PROPOSED? YES❑ NOS EXISTING SQ.FT. I�)C•L)
EXISTING BEDROOMS Z PROPOSED BEDROOMS TOTAL BEDROOMS_
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgom nt 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 structuro(s)for review and inspection. This permitlapplicatlon becomes nail&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)
r-1
� 03-31-2022
/ Si aNt o iiiirt ( ua stZ1e signed by the OWNER) Date
DEPARTMENTAL.REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSIIAL
PUBLIC HEALTH '{30125
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