HomeMy WebLinkAboutCOM2022-00105 - COM CD Environmental Health Review - 12/27/2022 (3) ��No ''`^s� MASON COUNTY COMMUNITY SERVICES Permit No: YYl •• O�'.• I6),
._ t,. PERMIT ASSISTANCE CENTER: f 1'� 11.
.BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL + '.:i....r t•^
•0 615 W.Alder Street,Shelton,WA 98584 /"'(/`�
y.- Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone f� {17 l r �� 2 tt l
i y Belfair.(360)275-4467•Phone Elma:(360)482-5269 L7 VJ 2 t` 4,122132
BUILDING PERMIT APPLICATION 615 W.1tiiltilikISt& et
PROPERTY OWNER
" INFORMATION: CONTRACTOR INFORMATION: - ,E I V _ . ;'
NAME:/ $M COI/ 1,'� i re 01 # NAME:
MAILIN AD RESS: (f (3B)( I 10 MAILING ADDRESS: !l� r-t-
CITY:$jip��/1 STATE(Aj$ ZIP:9 QSp9 CITY: STATE: _ZIP: `� �;i.•-
PHONE#1: 3 L v- Oh-5-533 PHONE: CELL:
PHONE#2: 3G0 ALa2f730 EMAIL: ,1l '-iW Alder Street
EMAIL: •T.Zi .E. L&I REG# EXP._/ /
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER
NAME - US+•Iin Z Were"- AI EML "WOP./L°�'� h C/ 7. r_'.
ZQ
MAILING ADDRESS 1n pi) do/ 1q/0 CITYSieo( STATE(./ 0'ZIP ITS
PHONE 3 L a- .( -5S3,3 CELL 3Lb-pug -Ff 750
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) a a 133/a la ooaQ ZONING 5
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS r CITY h 14-J
DIRECTIONS TO SITE ADDRESS v)< +0E is ✓ ( F
PrCki/iM1 re-A`
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO tit SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION 0 REPAIR❑ OTHER$1 ffodUI1o},,i
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) O f.QPGQ
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS r NUMBER OF BATHROOMS a
HEATED STRUCTURE? YES(Whole Bldg) YES(Pan[ajofBldg)❑ NO 0
DESCRIBE WORK Fire Od JAtilA DPrc2,c
SQUARE FOOTAGE: (proposed
1ST FLOOR33 b0 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
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 .111,FLOOR PLAN REQUIRED*
MAKE Ever;reen MODELQUckd(Cy YEAR II'I D LENGTH� { SCI �ry
WIDTH (DO g p " I
o BEDROOMS BATHS a SERIAL NUMBER �I i b O& 4-0
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW a EXISTING❑
PLUMBING IN STRUCTURE? YES . NO❑ Ifyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO4 EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER acknowledges that submission of inaccurate information may result in a stop worts 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 8,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 APPLICATIO 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
x y/19/,2.) Cool pitted a -2.1-2.
Signatu WNE st be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH 7 Jtr1.,V ‘-I(I )
RR5 Zoning
Front Yard Setback.25'.
a Side&Rear Yard Setbacks.Residential dwelling
and accessory structures is 20'.
OR 10%width of lot if not more than 100'wide
OR approved ADV
01/04/2023
33e.-0 APPROVED1
MASON COUNTY DCD PLANNING Digitally
SCOTT RUEDY,AlOP signed
sane la.d)by Scott
Ruedy
Approved by SUP2022-00003
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EH Approved --ILA -sat
Jeff Wilmoth 01/1912023 I r ,114.,....
7Q
EH Setbacks
1)Drainfieldtreserve requires 10'setback from
footinglfoundations �• 1
2)Septic tanks require 5'setback to all ��— 'E�. o.+d �+'•^
footing)foundations �� °' f
3)No foundation/perimeter drains within 30' PiC 1--
down-gradient of dra nfie d)resarvn area. Iao+a•alwwa.co.aa.7+e� kering Road MINI p. ""'b"""""'""a'�""'�'
4)No cut banks(greater than Sft and over 45 aw„t and•^pint 1XOS
degrees)within 50ft downgradient of
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