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HomeMy WebLinkAboutBLD2022-01117 - BLD CD Environmental Health Review - 8/23/2022 (2) 00 cop4,r MASON COUNTY COMMUNITY SERVICES Permit o: s U2 ` �� * ; PERMIT ASSISTANCE CENTER: F�EC I # •BUILDING•PLANNING •PUBLIC HEALTH•FIRE MARSHAL 615 W.Alder Street,Shelton,WA 98584 AUG 2 3 L022 \ 0# � Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone /' Belfair:(360)275-4467•Phone Elma:(360)482-5269 ��,� \ �xu / 615 W. Alder Street BUILDING PERMIT APPLICATION PRO PERTY OWNER� INFORMATION: CONTRACTOR INFORMAT 0N�p``' .NAME: `V NAME: �� (S ^ � MAILING ADD SS: MAILING ADDRESS: Gv STATE: ZIP:____ STATE:_Z P:q. CITY: CITY: a PHONE: CELL: PHONE#1: 70/ ��a 7 9© — EMAIL ' PHONE#2: L&I REG# EXP. / /_ EMAIL: � 4 '�' " PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑ EMAIL "H�t —C.. 1i NAME ��,. 17 el hS ' L �JS'�`�. CITY — o H r TE MAILING ADDRESS �'� ' � "'"ten CULL 7t�a2 �' 7 �� PHONE PARCEL INFORMATION: 32 a 7�sl- o�� 7� ZONING PARCEL NUMBER(12 Digit Number) FIRE DISTRI T LEGAL DESCRIPTION(Abbreviated) P CITY l �' SITE ADDRESS n .to ip DIRECTIONS TO SITE ADDRESS IS THE PROJECT WITHIN 300 FT OF SLOPE(S)E FOLLOWING:GREATER eTHAN 14%: YES❑ NO SALTWATERl that apply): PROPERTY WITHIN 200 RIVER/T OF CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF J STREAM❑ ❑ LAKE ❑ REPAIR❑ OTHER ❑ TYPE OF WORK: NEW ADDITION ❑ ALTERATION ❑ USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) NUMB R OF BATHROOMS IS USE: PRIMARYX_SEASONAL❑ NUMBER OF BEDROOMS O HEATED STRUCTURE? YES (Whole Bldg) ❑ YES(Part[s]of Bldg) ❑ NOg` DESCRIBE WORK i t id =iiii SQUARE FOOTAGE: (propose+existing) sq.ft. 3RD FLOOR [ . sq•ft. BASEMENT_AA._sq.ft. 1ST FLOOR i���sq.ft. 2ND FLOOR N �"_ sq.ft. STORAGE sq. ft. OTHER_ilik sq. ft. DECK��sq.ft. COVERED DECK 1J/� sq. ft. Attached❑ Detached❑ GARAGE�� sq.ft. Attached❑ Detached CARPORTIL *4 COPIES OF THE FLOOR PLAN REQUIRED* MANUFACTURED HOME INFORMATION: LENGTH YEAR MAKE N fi MODEL WIDTH SERIAL NUMBER __._ BEDROOMS— BATHS ENVIRONMENTAL HEALTH: / NEW ❑ EXISTING` SEWAGE/SEWER SOURCE: SEPTIC SEWER YES ❑ NO If yes, attach completed WateequaForm PLUMBING IN STRUCTURE? �� N��� S`�V^r` EXISTINGrrt�y SQ.FT._-- PERIMETER/FOUNDATION DRAINS PROPOSED? YES ii TOTAL BEDROOMS C� r PROPOSED BEDROOMS EXISTING BEDROOMS N/a� OWNER acknowledgesw.Ideclare a that I am the ownersccurate information may and I further declare hattesult in a stop I am entitled oNork receive thisrder rperm permit and revocation. to do the work as proposed.I have is by obtained ed below.I permission that I am any easement er or legal obtained alive, epr sent all thethe information rtperovided is accurate cu ate and grants lder or parties of employees of Masserest on County accessls t phe above desect. The cribed property representative,represents that and structure(s)for review and inspection.fo has permit/application 'of P 810 days. PROOF null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended period PROOF OF CONTINUATION OFWORK ON LL CA SEITHE APPLICATION TO BE EXPIRED. MASONEANS OF INSPECTION. INACTIVITY OF S 180 MORE WI IS BY PE PPLICATION OF DAYS OFCOUNTY CODE 14.08.42) r7 X .�i.N✓N Date Signature of OWNER ust be signed by the OWNER) APPROVED DATE DENIED DATE "TAGS/NOTES/CONDITIONS DEPARTMENTAL REVIEW _—_11111111111111111111111111 BUILDING DEPARTMENT _—_ PLANNING DEPARTMENT —_ m, FIRE MARSHAL CSZ I Tt >t von. HEALTH L 1)0 Z 0-o ao�� �a, j nac DF.D2, � wmnz°' oa �71�7Colfl N a m w v r'''' :U re. Ira m z o v o m ��� , gym 7 N co O. f�1 0m• Z13. 3 C PA '&oa a. asrip 1� 5 0 N NN m a X '7 5l u j' 7j` r+ 3;a m � 0 � cr w $ y N C N N -� (D0 �. F 3°�_ .4 - . S VW CD / � _ _ • � NF \ n t � A v fA CO 'S w o- o d " ''' n. (� ye m _ 3 7 r O fp ct'o3o II 3 x3 rsB, A 'U �, co N . cp 5 Of mua co a. . < (Si, 0 ? 3 n 00 41 fll S ir - - yr #c.b N m . . e 3 •- { '11 �I j -1; up .Z7 • fi,) /� m O W 3 , :I:6' 3 N CO n ° IJr cn ..1 ' / `-- —11 / i It/ 7. lith.. .., D 0 0 to ; 'rrI \ a I / / \Q of l i ) / / �9 F.' corn — } oZ_ _ 7 :27°1 rt �q. �I '' b, s to f 3 O ' ;ate , �. -, nIi a. / \ Ni \\\to\ \s,. 1 1 5, E 1 IN CPfis \c011 f111 co ��'� 1 co ��e5 "' ,-1 • _ L 4§-4 J,1 m ` c \ 1 15 \ \\�, Xcio CD , \ ,1 \ \ \ ; r �� 1 185 \ \ lt\ 1 \ 1 1 �� 3' r� to \ 4 b N 1-� \---)� M�� M/ ,� C7 s R� a NZ. ' U —" O -isE q3 Road Of Tralee �' N ft N E � 60. oN�� 6s �° 0