HomeMy WebLinkAboutBLD2022-01118 - BLD CD Environmental Health Review - 8/23/2022 ' '''1'1;, MASON COUNTY COMMUNITY SERVICES Permit No:
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PERMIT ASSISTANCE CENTER: RECEIVED
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ty •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL /`J" V
615 W.Alder Street,Shelton,WA 98584
f A Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone AUG 2 3 "LU11
'�•�- ,av Belfair:(360)275-4467••Phone E/ma:(360)482-5269 ENVIRONMENTAL
BUILDING PERMIT APPLICATntt4 W. Aber Street HEALTH
PROPERTY OWNER INFORMATION:—�� CONTRACTOR INFORMATION:
S NAME: PPNn/. Gf/1SaA9 NAME:
MAILINGADDJtFSS: 9/03 /lly��D c MAILING ADDRESS:
CITY: J e p,oJ STATE:P ZIP: CITY: STATE: ZIP:
PHONE#1: -745 a _ cev _ 4-79a PHONE: CELL:
PHONE#2: EMAIL:'
EMAIL:" L&I REG# EXP. /_/—
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER❑
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 3a/;Z 7 - ../--dd/7 f ZONING
LEGAL DESCRIPTION(Abbreviated) / FIRE DISTRICT
SITE ADDRESS ' ,9/ .,&-- / e2.e/ . TO-�/cc" CITY •��C/T�` ,4-.)/ 4.4
DIRECTIONS TO SITE ADDRESS ,vie :., U / 7 /
/!� �u �� tB ��o'�v �kc 6fI 1raik/c
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NOX_SNOW LOAD:__psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF X STREAM 0
TYPE OF WORK: NEW/K ADDITION 0 ALTERATION❑ // REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) PeS.'Je r,e.e. J�
IS USE: PRIMARY'`-' SEASONAL 0 NUMBER OF BEDROOMS ( NUMBER OF BATHROOMS 1 !Z-
HEATED STRUCTURE? YES(Whole Bldg)X YES(Part[s]of Bldg)0 NO❑
DESCRIBE WORK 'U l ld s-llw h sf.,Se
SQUARE FOOTAGE: (proposed) •
1ST FLOOR 960sq.ft. 2ND FLOOR ly//4 sq.ft. 3RD FLOOR ll/j¢ sq.ft. BASEMENT N/.4 sq.ft.
` /R 1i _, -- COVERED DECK /ZD sq.ft. STORAGE sq.(1. OTHER sq.ft.
GARAGE K35sq.ft. Attached 0 Detached CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: 1/A *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL (( YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: C Q_ Sly y WA i- C(r\4205-I%`A-')
SEWAGE/SEWER SOURCE: SEPTIC' SEWER❑ / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES16. NO❑ If ,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YESX NQ EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS I. TOTAL BEDROOMS
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
I 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 AP LICATION OF 18 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
/G�COUNTY CODE 14.08.42)
x ry,./lr�ryl� /—Z
Signature of OWNER S st be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATF. DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH l '( o GUr44 -
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