HomeMy WebLinkAboutBLD2023-00017 - BLD CD Environmental Health Review - 1/5/2023 COt;ya MASON COUNTY COMMUNITY SERVICES q..� n
a( y ' PERMIT ASSISTANCE CENTER: Permit No: � 4_,�1lL' � '
C
.BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL TT�I615W.Alder Street,Shelton,WA 98584
Phone Shelton:(360)427-9670 ext 352-Fax:(360)427-7798 Phone \ `0 J A N 05 2023Beffair.(360)275-4467•Phone Elma:(360)482-5269
BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY2� OWNER INFORMATION: CONTRACTOR INFORMATION:
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NAME: V V(MJ � fJ NAME: A/6(`-4I.S4C� Y , Wv p e e^fh
MAILING ADDRESS: 10 2 -I Ne 14.(N11SMIQ V Ii.CT MAILING ADDRESS: 1 I D . I 6.1.40 g
CITY: (C.(Ilk7.SfLVJ STATE: L A ZIP:‘1&'� CITY: C(-WliQ(( S STATE: LW- ZIP: fl 32_ J
PHONE#1: Zo(n (p 14 ob 19 PHONE: 0 2 2- CELL• <
PHONE#2: EMAIL: riot St i1A.eI'2YC , .a .Cb"14
EMAIL:_;t v,•b r,;.Ji)9�' Mg,1 P-Co" - I.&I REG# IJDILT {/V(C.B"LOL"7 EXP.Z/?o 1 z} Z T
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PRIMARY CONTACT: OWNER ft ' CONTRACTOR❑ OTHER` ❑ L
NAME r ArN MPL4PPM EMAIL brtan.Ylli.�,1DC1( 0014-12a CYnt t trj
MAILING ADDRESS(ou( f4V-14ari.�'317it j I lam,) C1 CITY k-IP:65•Te.) STATE(tea ZIP ergiiii, z Q
PHONE 2O(6 f~(9 6 62( 9 CELL -- O L1J
PARCEL INFORMATION: Cr =
PARCEL NUMBER(12 Digit Number) 42 O�C)a) I ( ZONING J 5 5
2
LEGAL DESCRIPTION(Abbreviated)L,RII.e CASiiftlIk14 •! 9- TlL(II,/ ( 4 /(2,5-FIREE DISTRICT O'3i 4 z
SITE ADDRESS 34-b I"-4 NIT J u(Fi 1F— Da- CITY t twl)G CD/p-T w
DIRECTIONS TO SITE ADDRESS e.4 o up -re, L-A ILE- C x1S'OW AN D AJ f- ( I% le/6i- r
4N D v Ntr P—/ t-TbN P, Mr. u ypfxe DP7 Prnapact, ot� RTt 1M tva tot ►J
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO e'
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that appty): �,/
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM IId
TYPE OF WORK: NEW i ADDITION❑ ALTERATION❑ REPAIR❑ SOOTHER ❑
USE OF STRUCTURE(8esideace:Garage.Coma• ial Bldg,Etc.) R V CD U C 0 (CI 2i XI)
IS USE: PRIMARY❑ SEASONAL NUMBER OF BEDROOMS •e- NUMBER OF BATHROOMS'
HEATED STRUCTURE? YES(WholeBldg)❑ YES(Part(s)ofBldg)❑ NO V
DESCRIBE WORK APD i a`o x 3S r P-V CO Veil- 1-3 P(LI`pO
SQUARE FOOTAGE:(propose+existing)
1ST FLOOR sq.tt 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. S 1'ORAGEt sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT j' O sq.IL Attached❑ Detached B.'"'"--
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE `E �> 101vt� MODEL YEAR LENGTH
WIDTH DRM BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: z Appr.vad gym i1 t1o+(&'S1S1LB)
SEWAGE/SEWER SOURCE: SEPTIC V.- SEWER❑ / NEW[' EXISTING❑ 24-`
PLUMBING IN STRUCTURE? YES❑ NO L'1' If yes,attach completed Water Adequacy ornt
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO2'''--- EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS e 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 as 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.'unducfr g 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 nut&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)
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�8fgnatur f OW R(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
i FIRE MARSHAL
PUBLIC HEALTH ] + I /7-5 U ( CALL &-!a
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(TOPOGRAPHY PROFILE: j,01- I S Liv FL- 6,,,,: l ,14- . ;:''i;,ok ?'1 I `,'+,,,."_
Direction: I Scale: 1 Approval:for office use
�'�. � `Building:
{Building Permit number:?7k4 20 2 2 - OOC i 1 .. Za
r2 Planning:
Owner/Applicant: r PlAN In A ()'n'� Date of
E application: Env. Health:
i Parcel Number. 42 L Cit- — G'"` _.- t.. C.: j l I ` (5./Z0