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HomeMy WebLinkAboutBLD2022-01117 - BLD CD Environmental Health Review - 8/23/2022 ;oK cox,,,, MASON COUNTY COMMUNITY SERVICES permitNo�� �1,.�U2(�a�-- I A r� PERMIT ASSISTANCE CENTER: I .BUILDING •PLANNING •PUBLIC HEALTH•FIRE MARSHAL RE ' 615 W.Alder Street,Shelton,WA 98584 AUG 2 3 i022 Or"'t WI ... Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone ^ `^ Beltair.•(360)275-4467•Phone Elma:(360)482-5269 w, !�`� '"" 615 W. Alder Street BUILDING PERMIT APPLICATION PROPERTY OWNER INFORMATION: CONTRACTOR INFO ��NARMATL ENI.PO`- NAME: �P�717/ S r , �p!,�/1�© NAME: G, NJ 1� CC,VVA�,L�y"�t' MAILING ADDR SS: 9 I f5 uJ and r MAILING ADDRESS: ` CITY:. .4e/ ", STATE: /,o,4 ZIP: ��5 CITY: STATE: ZIP: PHONE#1: 70/---52ts Z 7 2© PHONE: CELL: PHONE#2: EMAIL : EMAIL: 4/ qf/�,,rs� �l-1d_wgi L&I REG# EXP. /_/ PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑ ,/ NAME 1.6=11 en f {1 a We;h JI II .+J EMAIL c/L1 1 k 1 El h75•e-$ imf a! --C6i4i MAILING ADDRESS 9t0 Ld_ Lc1y24�otbe de CITY_cJjr/*7 ` STATE wi9- Z 9g•4-;-y PHONE CELL •7,a 5-et/ -- PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) .�.. /a 7—�-/" o >/ 7/ ZONING LEGAL DESCRIPTION(Abbreviated) J s FIRE DISTRICT SITE ADDRESS ��- g •�- �ota O*- 7y2!e'' e CITY 4r/ iul Z41- ` gS- 72( DIRECTIONS TO SITE ADDRESS .e i-i. IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER❑ LAKE ❑ RIVER/CREEK ❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF STREAM ❑ TYPE OF WORK: NEW ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(Residence,Garage.Commercial Bldg,Etc.) j21,..V,1 e ..S142 IS USE : PRIMARY SEASONAL❑ NUMBER OF BEDROOMS 9 NUMB-ER OF BATHROOMS cO HEATED STRUCTURE? YES(Whole Bldg) ❑ YES(Part[s]of Bldg) ❑ NOg` DESCRIBE WORK ; Id 1/20"K, 1_90‘,-2,1 e SQUARE FOOTAGE: (propose+existing) � 1ST FLOOR 6J sq.ft. 2ND FLOOR N/i sq.ft. 3RD FLOOR �f//y sq. ft. BASEMENT NA. sq. ft. DECK t-►� sq.ft. COVERED DECK�1/a sq.ft. STORAGE NA}- sq. ft. OTHER {1/4Yf� sq. ft. GARAGE +3 5 sq. ft. Attached❑ Detached$\ CARPORT NM-- sq. ft. Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE N/fi MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC( SEWER❑ / NEW ❑ EXISTING`6 PLUMBING IN STRUCTURE? YES ❑ NON If yes, attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES ;"i' N 5��� EXISTING SQ.FT. EXISTING BEDROOMS N�/3- PROPOSED BEDROOMS jJ/ 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 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 PTA PPLICATION OF 180 DAYS OF M COUNTY E ILL CAUSE a THE APPLICATION TO BE EXPIRED. (MASON /� t p_i.., D�DZ .42) X �2''�z Date Signature of OWNER ust be signed by the OWNER) DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL � (j� \ ���� PUBLIC HEALTH '"C ' -I1)G'Z� L Wiz%z5cn50 0-o ao *m `<sv. j 2 a�Da.Dg, m ,.\ co rpm a Z w o o. OM�11�7 OM. \\. 4 7c m O 'ai CD co 92. � N N m V�� � 3 v� 7 N �, o, � o0rn pce w 2 for a. .• 5. ( N o N �o � a VP `:, - 'N N N ��- o co $8 N Q I rn n _ 3 g NAY V• �A I - •� ii n/ f ` _ o 2 N3 co I A t , i O:' O v pU M I I a. O O x tp m / m m o m 44 d W Wco o / o v I>71i9mLl a. i co r _ I c� �y cn ti 3 a) -, -1 - r . ta 3• 0 41 i' 3 ip• 3 rsei 0 u) QO O N U) a ID p 1 > 2 I < (11 � ? m in al(D ,� "it S� �' N (p # 01 .rti� II ! ati. Co D mo co o to J r I I •r W (11 r o $ 23 f '� - N 3 W _' / / �� i M 's /7 / co• jog :�' �(r� w \d;' no ?6 ! I o (pmJ. J 3 C\ ��\\ / 3��0, �.. . , - I rn N ga 0 0 3 r R. 'll.: rl Q -% 7\\ . s �T1 , 1 \ . �, E 1 1 `° \C. • o, 3 l \Ct 1% 1 1 .. 1 j ? Z1 1195 1 \_ 4111‘111A. s 1 ,1 0 1 1i ,1g5 3 3 e V` -) G - 1 i _ y .` � d Cr0 ' \\ ____\,---) \ vv,--- 411, ?... C3 Nn M 9 3' �° N E Road Of Tralee ?600 v N a • ua er2 6' -1 Ct (D — MIL MIID