HomeMy WebLinkAboutBLD2023-00017 - BLD CD Environmental Health Review - 1/5/2023 (2) �r9ox C ~ao MASON COUNTY COMMUNITY SERVICES te3) .1\9S0-1-
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PERMIT ASSISTANCE CENTER: Permit No:
• _
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
615 W.Alder Street Shelton,WA 98584 /
Phone Shelton:(360)427-9670 ext 352-Fax(360)427-T798 Phone \ (0 J A N 05 2023 •
Bel(air.(360)275-4467•Phone Elmer:(360)482-5269
BUILDING PERMIT APPLICATION • 615 W. Alder Street
PROPERTY2( n OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: V lZ(km Po PLOW A' NAME: I1Ts r-J'-I+SlCL9 Y , ehir cp e i.-4-3
MAILING ADDRESS: i0 ZZJ NC 144N61ST?N II/$tu CT MAILING ADDRESS: (I D 4eJe -J-O g
CITY: (UN(,iS` J STATE: Lv A ZIP:qB30, CITY: C l-W(-dad( S STATE: itjf} ZIP: ? 532 J
PHONE#1: 76 G 15 0(9(q PHONE: 0 2 2-935niCELL• Q
PHONE#2: EMAIL: el or 91 I'In- FT;f M Cam'" F'
EMAIL: •-r. to•li Dzi•,/��� IN fQ-Low— L&I REG# n/'DIZ1#(f 02-OL7 EXP. 7/20/24 'L
PRIMARY CONTACT: OWNER le CONTRACTOR❑ OTHER❑ LU
NAME f a A n) b121?(AJ'I'J EMAIL 6ri n.4rx..:.i:iLAM /9 wt ,t'J•tit J
MAILING ADDRESS(0221 I�it(4kfAr IDN1 Ir/ CI" CITY (L{p.6 �*J STATE 4o".'a ZIP__ ..6
PHONE 206 i<19 6(D( fj CELL " r1 w
PARCEL INFORMATION: rat =
PARCEL NUMBER(12 Digit Number) 4Z2 04 D CO I ( ( ZONING 1Z.9.5 >
LEGAL DESCRIPTION(Abbreviated)" LPIt E CM a tJ j 'Mt l(! S 4 /(�FIRE DISTRICT 030
!
SITE ADDRESS 34b 4 MT J ULi — D . CITY (lwh G 17D gr W
DIRECTIONS TO SITE ADDRESS 6 o v tAklGE. CAS i-I'NA AN- D tJ I-c1`� l l°() ir/( H-7
nN EXiv pW KD. t, -r o tJ o mt. .iy j7fTW DRT PP6p-t� D N R-11 IA Pa it�o err l 1
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN I4%: YES"' NO 9'
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that appty):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM(t.
TYPE OF WORK: NEW j ADDITION❑ ALTERATION❑ REPAIR❑ OTHER
USE OF STRUCTURE(Residence Garages Bldg,Etc.) ,V Cover- CC OIzT)
IS USE: PRIMARY❑ SEASONAL NUMBER OF BEDROOMS 'e" NUMBER OF BATHROOMS'&
HEATED STRUCTURE? YES(Whole Rldg)❑ YES(Parris]of Bldg)❑ NO V
DESCRIBE WORK APO ($`X 35( FZU col/VA- T"D(74-4p02 1
SQUARE FOOTAGE:(Per pose+existing)
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.R
DECK sq.ft. COVERED DECK sq.ft. S'FORAGE6 sq.ft. OTHER sq.ft_
GARAGE sq.ft. Attached❑ Detached❑ CARPORT 67 17 sq.ft- Attached❑ Detached 3--""
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH ) .DR BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: Appmvad PZV'Mif j 004't115 t1
SEWAGE/SEWER SOURCE: SEPTIC[7 SEWER❑ / NEW[fir EXISTING[] •_ Db i pAN+ id
PLUMBING IN STRUCTURE? YES❑ NO If yes,attach completed Water Adequacy Form
1 PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NO[]" EXISTING SQ.FT.
EXISTING BEDROOMS 119 PROPOSED BEDROOMS TOTAL BEDROOMS
4 OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Adeiowtedgement of such is by
signature below.I declare that I no 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 an the necessary parties.inducing 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 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)x 1
/
i Z1'Z�7 l 2o 2
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natur f 0 R(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL �� p (�� �
PUBLIC HEALTH 4 \12.AI7 5 GO '��)`(\ CA--6 " -el
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TOPOGRAPHY PROFILE:
Direction: Scale: Approval:for office use
���. 2a � Building:
Building Permit number: ? " O��— .. Planning:
�, �Iv ;(- tii Date of
Owner/Applicant: r l application: I Env. Health:
' — �= 11 f j I f5/Z07''
iParcel Number: --r-Z� C<�