HomeMy WebLinkAboutBLD2023-00004 - BLD CD Environmental Health Review - 1/4/2023 01MINIIIMIIIIk v.
tl;,,.1`�`'.17^1.1'i MASON COUNTY COMMUNITY SERVICES Permit No: I C E2e L
PERMIT ASSISTANCE CENTER: v
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-% •BUILDING•PLANNING•PUBLIC HEALTH.FIRE MARSHAL
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•I l• - 615 W.Alder Street,Shelton,WA 98584
\--1 . - Phone Shelton:(360)427-9670 ext.352•Fax (360)427-7798 Phone co A N 04
Be!fair:(360)2754467•Phone Elma:(360)482-5269 ��ICJ
BUILDING PERMIT APPLICATION
615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:John Hayes NAME:Same
MAILING ADDRESS:'Blueberry Rd MAILING ADDRESS: T
CITY:Etna STATE:WA ZIP:98541 CITY: STATE: ZIP: Z
PHONE#l: PHONE: CELL:
PHONE#2:360-500-6259 EMAIL: C
EMAIL:i kin. 6...- hLt L�CJp E ;;L�&I REG# EXP._/_/_ =
PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER 0 M 0
NAME Sd1e EMAIL D z
MAILING ADDRESS CITY STATE ZIP E
PHONE CELL
PARCEL INFORMATION: = rT1
PARCEL NUMBER(12 Digit Number) I I<c-i - .5 7.,OO I I c.) ZONING _ —I
LEGAL DESCRIPTION(Abbreviated) .m'nor.u*anmrt+cro.nuauro.•.uu.uv'coun.WSmmm FIRE DISTRICT -
SITE ADDRESS 596 E Pointes Dr W CITY Shelton r
DIRECTIONS TO SITE ADDRESS Left after gated entrance,address is about halfway to North Beach,power transformer at driveway entrance to right.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO❑/ SNOW LOAD:ZS psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 OTHER
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc)Residential
IS USE: PRIMARY❑ SEASONAL 0 NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS I
HEATED STRUCTURE? YES(Whole Bldg.)0 YES(Parr/s)of Bldg)❑ NO 0
- - DESCRIBE WORK New home construction,cabin with lofted ceiling in great room
SQUARE FOOTAGE:(proposed)
1ST FLOOR 105° sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK 160 sq.ft. COVERED DECK se sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached 0 Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED INFOI;MAT N: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAK MODEL LENGTH
1DTH BEDROOMS BATHS SERIAL NUMBER
., ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER 0 / NEW 0 EXISTING 0
i PLUMBING IN STRUCTURE? YES '❑ NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 2 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
and structures)for review and inspection. This permit/application becomes null 8 void if work or authorized construction is not commenced within 180
days or if constructon 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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John Hayes �,,,IS ;^ �^^-�°„°^ 12/20/22
5,9n•.,,.11 0'OWNER(M,,., n. . .a ,, ,,.OWNER) D.,.
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL I
PUBLIC HEALTH �I_ S I2 5
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(>� 7o BUILDER/ DESIGNER: OWNER PROJECT LOCATION:
ND mm S)'$
NJ O' 3 JOHN AND JANE HAYES LOT 119
n = 1> 0 7 BLUEBERRY LN 596 E POINTES DR W
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oN N z —I ELMA, WA 98541 HARTSTENE POINTE
NJ 360-500-6259 SHELTON, WA 98584