HomeMy WebLinkAboutBLD2023-00164 - BLD CD Environmental Health Review - 2/9/2023 ` MASON COUNTY COMMUNITY SERVICES Permit No: RlCi 2)23 CZ RP L-I
/• °'1 PERMIT ASSISTANCE CENTER: RECEIVED
BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
(4. 615 W.Alder Street,Shelton,WA 98564
;:'i;s.: '•_ � Phone Shelton:(360)427-9670 ext.352-Fax:(360)427-7798 Phone A FEB 0 9 2023
\ tit Belterr.(360)275 4467•Phone Elma:(360)482-5269 1V
BUILDING PERMIT APPLICATION _ 615 W. Aid
r Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: FY'ahci S ( 1n . Q NAME:
MAILING ADDRESS: P(i Ho P't 7 7 MAILING ADDRESS: _
CITY:S Ite.( STATE: IVA- ZIP:q';'S-S-4/ CITY: STATE: ZIP:
PHONE#1: 40 -70-- i 7t'0 PHONE: CELL: rn
PHONE#2: 3(00 -`t14 - $3I7 EMAIL: Z
EMAIL: •ftra n k to I N Ee r I1et-At(-c-ow. L&I REG# EXP._/_/ <
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER 0 = Jv
NAME Fv^0.rtk 'f t•t-i"er EMAIL "cYaw4-eI.%1-e.- e_, gtiAa_41• Ccw, M 0
MAILING ADDRESS -!Pe) t.?Q., /'177 CITY Ike,-1-e STATE .ti-ii- ZIP 4V41;Li
PHONE air 0- I,)1 -I N v CELL G••
PARCEL INFORMATION: ---1 m
PARCEL NUMBER(12 Digit Number) 3 k A 7- 33 - /066 2- ZONING g!2.3— Z
LEGAL DESCRIPTION(Abbreviated)TR Sc-!j 6 P S va S 4. f G L 2-, FIRE DISTRICT _ --'1
SITE ADDRESS SE Biti•.-S Sw,Jer hod' 'RQBJ CITY SLC ill, Wit- ' 57s`1
DIRECTIONS TO SITE ADDRESS_._R r3 117 /Q-v-GRd i I' i-v 13/'1 V ,Scot` Cr r
7‘iI
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO(7 SNOW LOAD:�Cpsf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW a ADDITION❑ ALTERATION 0 (REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Etc. 4 D(,.( t:.S i�e.'+G t
IS USE: PRIMARY tg SEASONAL❑ NUMBER OF BEDROOMS -q NUMBER OF BATHROOMS .---
HEATED STRUCTURE? YES(Itlral'Bldg)al YES rwan/aJofehig)0 NO 0
DESCRIBE WORK/tt S-k{I Ftt4 E - J H-"-' e. c1SI..It Kc- . r [, m A- � `"i
SQUARE FOOTAGE: (proposed)
-' ft. BASEMENT . s .tt
1ST FLOOR�3! sq.ft. 2ND FLOOR - sq.ft. 3RD FLOOR sq. q
DECK sq.ft. COVERED DECK sq.ft. STORAGE , sq.ft OTHER . "- sq.ft.
GARAGE f sq.ft. Attached 0 Detached❑ CARPORT sq.ft Attached❑ Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF TILE FLOOR PLAN REQUIRED*
MAKE t"(e.r.4•Wiac1 rvrr i re e- MODEL C- e(A.K ;)4 t10..g1"' YEAR -''2 3 LENGTH lir
WIDTH 1•3 r y t 1 •BEDROOMS 3 BATHS —-• SERIAL NUMBER T 8.1)
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC a SEWER❑ I NEW j2i EXISTING❑
PLUMBING IN STRUCTURE? YES CA NO❑ Ift es,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOZ EXISTING SQ.FT.
EXISTING BEDROOMS ,C) PROPOSED BEDROOMS - TOTAL BEDROOMS_ .3
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 parries,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&void ff 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
) -- ' .---7
COUNTY CODE 14.08.42) / j
/' v/f/.ozy
Signature of 0 ER(Must be signed by the OWNER) : Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL rr''
PUBLIC HEALTH D 2 vt C�N t \1 i�V,)
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