HomeMy WebLinkAboutBLD2022-01088 - BLD CD Environmental Health Review - 8/16/2022 (2) MASON COUNTY COMMUNITY SERVI V ..Oaoaa—olpg8
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Vi PERMIT ASSISTANCE CENTER:
°E £fir •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
yr.,, 615 W.Alder Street.Shelton,WA 98584 AUG 1 6 2622
0`r:.:.,.•,--;..- Phone Shelton:(360)427-9670 exL 352••Fox:(360)427.7798 Phone ENVIRONMENTAL
7 -tea'r .,.,
Bohai,:(360)275.4467•Phone Elms:(360)482-5260 c 615 vv Alder Street
. i 6 W. /VJ HEALTH
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: \°i 1
° NAME: D1:27 ,siM1,utai, NAME: rue-- (fiN orne,_5,
MAILING ADDRESS: t a 1-�E,8 { i- f 1 MAfLING ADDRESS: _ U,L.CITY:`�jo�. 1,i/ STATE: t-OAZIP! _ CITY: are ni , STATE: >A) "ZIP:
0 PHONE/l1: PIIONE: y0_'�-15H Ciiitii
PHONE/12: EMAIL:
8 EMAIL: L&I REG -7S' S(Q4p—(x. XP.—/ /—
1 D PRIMARY CONTACT:
OWNER❑ CONTRACTOR 4 OT iER� � �i -' _fog _,,t� f (�/}
NAME Vt L SKi one,'" EiMAII.YT��T.,j } JrV{U7 co -rt., OP
MAILING ADDRESS CITY STATE ZIP
PIIONFJC-7/0-(p 8 lQ CELL
PARCEL INFORMATION:
i PARCEL NUMBER(12 Digit Number)_ E7.-3 3 2- -`'I - 0 UC?o Z ZONING
LEGAL DESCRIPTION(Abbreviated)Lei' 42 Si I"-$ t j f:-4l 5 %i 4••Al-FIRE DISTRICT
o sin ADDRESS—_tC' I 1JE 131a4'1si 2 -.- ---CITY ' ivi•- L`i I_.
DIRECTIONS TO SITE ADDRESS il e,c.,-L•S.S . ',•-e-A -1.i ins 6e✓ l[rn ci 1.-t ht'a J,1 t,-
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO IX SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Cheek all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW❑ ADDITION 0 ALTERATION❑ REPAIR 0 OTIIER`Z . IP-(..ti-I'^e-!'{-
USE OF STRUCTURE(Rinidrnre.Garage,Commercial Bldg.Etc.) I k s t.1.1 c rt C F..- (.5 (" 0.--) ___
IS USE: PRIMARYA SEASONAL 0 NUMBER OF BEDROOMS_ 14___ NUMBER OF BATIIROOMS ,
HEATED STRUCTURE? YES(whole Bide)1i YES(Porthlof Bldg)❑ NO
DESCRIBE WORK Demo N.Dispose of Fisting Mobil&Replace with New
;.------
SQUARE-FOOTA(;E:-. osn/;
(1ST FLOOR op sq.I1.,2igD FLOOR sq.I1. 3RD FLOOR sq.II. BASEMENT sq.It.
`DECK .. -sq:(t COVERED DECK sq.II. STORAGE sq.ft. OTHER sq.R.
GARAGE sq.II. Attached 0 Detached 0 CARPORT __sq.II. Attached❑ Detached 0
O MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE S r�v-"'(.' (L- MODEL__-_I S 5(.._i } YEAR 2_C)- $ LENGTH to 2,t
WIDTH :3b I IEDROOMS .
_ / BATIIS u--)- SERIAI.NUMBER T - 'l
ENVIRONMENTAL HEALTH:
• i'
SEIVAGFJSEWER SOURCE: SEPTIC SEWERX I NEW❑ EXIS•TING
PLUMBING IN STRUCTURE? YESli NO❑ Ifyes,attach completed Water Adequacy Fornt
PERIMETER/FOUNDATION RAINS PROPOSED? YES❑ NO2'' EXISTING SQ.FT. 1 f'CO
EXISTING BEDROOMS Z PROPOSED BEDROOMS TOTAL.BEDROOMS_
OWNER acknowtodges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgo�of such is by
signature below.I declaro 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 Intorost regarding this project. The owner or legal
roprosontalivo.represents that the information provided is accurate and grants omployeos of Mason County access to the above described property
and structuro(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
(-------Bail COUNTY CODE 14.08.42)
,r • /N,l� 03-31-2022
atu o ( usA signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH \Qier *),h.-
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