HomeMy WebLinkAboutBLD2022-01327 - BLD CD Environmental Health Review - 10/13/2022Imts
ev�,rx Pl� MASON COUNTY COMMUNITY SERVICES Permit No: 5k1 2�).;: - O I. )vl I--
1 PERMIT ASSISTANCE CENTER:
i •�I• •s •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL A RECEIVED
615 W.Alder Street,Shelton,WA 98584 'rk!l
y'f 4;7 Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone �J ` t
o.1yYo')• ,^y ti� Belfair(360)275-4467•Phone Elma:(360)482-5269 �`1(2-) O CT 1 3 202?
F71.1�tI f LL
BUILDING PERMIT APPLICATION {{;;`1
PROPERTY OWNER(INFORMATION: CONTRACTORy INFORMATI�SN: W. Alder street rn
NAME:�n,e,l Rowe, , NAME: RIS I6l/� ee I O c,- <
MAILING ADDRESS:j(Qyo y t y th Aye j,� MAILINc�ADDRESS: et0 r 1/2 +T�
CITY:Pv AL 10 STATE:4y/ ZIP:c7 g,3 7L/ CITY: S he I IVO STATE: ZIP: 5�5 / =
PHONE#1� T PHONE: y2 7.9 vie...! CELL: D 0
PHONE#2: EMAIL: S
EMAIL: L&I REG# P. 1/ 112/33 E
PRIMARY CONTACT: OWNER❑ CONTRACTORS OTHER❑G 11 r,.� = M
NAME C�5 +I EMAIL �h •\os1L1,Ca rf�G.t `o \ Z
MAILING ADDRESS c O tot. 219 Z CITY She STATE)I P1 ZIP-�.ti}� .--I__
PHONE T__P_ l CELL 11/p• 5 3
PARCEL INFORMATION: r
PARCEL NUMBER(12 Digit Number) y2 b ki•5 1• OIJOA ZONING f ) "5
LEGAL DESCRIPTION(Abbreviated)Li S �r►nnIAK1 44'(, -MS $$4"j 151 FIRE DISTRICT
SITE ADDRESS Lo I N IULOYN )Y- CITY }-i-cods psf4-
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NOQSNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apple):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW4f1 ADDITION❑ ALTERATION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) Res,A es...C-
IS USE: PRIMARY SEASONAL 0 NUMBER OF BEDROOMS 2. NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Part[s]ofBldg)42' NO 0
DESCRIBE WORK isgg Sf Qec&IdenLe_ w/ SK',St' oaC'C.C{.P.
SQUARE FOOTAGE:(proposed) /�/ JJ o0
1ST FLOOR WV0 sq.ft. 2ND FLOOR 9t7 O sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK IUD sq.ft. COVERED DECK i C=-) sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE 5%9 sq.ft. Attached Detached 0 CARPORT2.y O sq.ft. Attached' Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEW❑ EXISTING'
PLUMBING IN STRUCTURE? YESigr NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 N( EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS Z TOTAL BEDROOMS 2
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
0 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 • • TION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERM I I OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
x /0/ 7/2z
-tgnature o NER Mu be si ned b the WNER Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH \ger OO(3Jz,3 COr S -e9
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