HomeMy WebLinkAboutBLD2022-01301 - BLD CD Environmental Health Review - 10/5/2022 MASON COUNTY COMMUNITY SERVICES Pe669,0 i•R 2 - DI 6 0 I
1 , ��\ PERM(T ASSISTANCE CENTER: R E
3 !•BUILDING•PLANNING•PUBLIC HFAI 7H•FIRE MARSHAL ( `
615 W.Alder Street,Shelton,WA 98584
\.'> :» `:..•!! Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone OCT - 5 LULL
\„` :.�i.;` Beltair.(360)275-4467•Phone Etna(360)482-5269
"'� BUILDING PERMIT APPLICAIlDW Alder Street
PROPERTY OWNER INFORMATION. • COrITI i.CrO r i O-R;LMA ENVIRONMENTAL
NAME: G !DRESS: B r c , Ce Gf NAME: -- - - HEALTH
H
MAILING AD � 9-5-4Y MAILING ADDRESS: f 1
CITY: _ 'C STAT ZIP: F5/3 CITY: STATE: ZIP:
PHONE#1: 0'• '8/ y PHONE: CELL:
., PHONE#2: EMAIL:
EMAIL:h/t; I_ Lc (l &' q�7lira'L - C y'si L&I REG# EXP._/_/
PRIMARY CONTACT: OWNERS CONTRACTOR OTHER❑
NAME :T S/1r�_e G! EMAIL Tor tAla/.t Gv rV gp4a,f •, ,�tl
MAILING ADDRES CITY f,QC/f' STATE//..44/ ZIP /S
PHONE cO 9. CELL
PARCEL INFORMATION:
PARCEL NUMBER(I2.Digit Number) 3,2 0 /-S/ -0.2,0/O p
ZONING Q e fq' log_
LEGAL DESCRIPTION(Abbreviated)( o t j 8L/et,/
LEGAL ee75118,S Sr RE DISTRICT 5--
SITE ADDRESS 3!/6 Soun+Crv,e A,,day CITY sWri c7M IVA 9 85?ei
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO❑
IS PROPERTY WITHIN 200 FT OF I HE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
' TYPE:OF WORK: NEW J ADDITION❑ ALTERATION U REPAIR❑ OTHER❑
USE OF STRUCTURE )Zesidence,Garage,Commercial Bldg,Etc.)
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURES YE (Who! Bldg)[J YES(Port[s]of Bid ❑ 0❑ or L1 l Fi._
DESCRIBE WORK_ �\h/`�'�, 0.,, j , 2 1— 1 1
SQUARE FOOTAGE: (propose+existing)
1ST FLOOR _sq.ft. 2ND FLOOR _sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
0,, DECK_ _ _sq.ft. COVERED DECK sq.ft. STORAGE_ sq.ft. OTHER sq.ft. '
GARAGE_ _sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF fHE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWERSOURCE: SEPTIC XI SEWER[1 / NE EXISTING❑
PLUMBING IN STRUCTURE? YES NCy If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS_.
OWNER acknowledges that submission of inaccurate information may result in a st 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 tion work is suspended.for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS B]E MEANS.OF INSPECTION: INACTIVITY OF THIS .
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTYOODE 14:I18.42)
' X (-(z ' 1c ab as
Signature of OWNER(Must be signed by the OWNER) ate
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL ��jj
PUBLIC HEALTH *NV) (6-0��2,Q
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• "'• WASHINGTON
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SITE PLAN LMIKE BIGGS
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+ O1 i'' 1736 Riddell Road Suite 100,Bremerton,WA 98310 ,
MIKE BIGGS