HomeMy WebLinkAboutBLD2023-00041 - BLD CD Environmental Health Review - 1/12/2023 •:IG:11... 31d 202 3 - C L
�:Y �•1��r MASON COUNTY COMMUNITYSERVICES Permit No•
PERMIT ASSISTANCE CENTER:
,...-4' •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL ( I \/ ('
. ..,• - L t*7 p -p 615 W.Alder Street Shelton,WA98584 �/ • I-- -� t---I �/
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Z, Al� Phone Shelton:(360)427-9670 ext 352•Fad(360)427-7798 Phone `I(1
`. �yy Beak:(360)275-4467•Phone Elma:(360)482-6269• _ ,,.n
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: 615 W. Alder Street
NAME: yy"rho n d 1 S S t_,^ - NAMP c r .
MAILING ADDRESS: f, 2L¢0 YT t L4.k 61 G ADDRESS: Z
CITY: ff,c,I tAhr S'PATE:_i.,/t LIP:q 45 L g STATE: ZIP:
PHONE#1: '?>6 0 so I -N b b'7 PHONE: C ,I.I F : r'+•
PHONE#2: 15(,0-$d i -D y EMAIL: _ W
EMAIL: U'G.1i b izf71U4 t{DtMa L.( m T A'T REG# EXP. / / m
PRIMARY CONTACT: 22 OWNER 51 CONTRACTOR❑ OTHER❑ > Z
NAME ir., and C v.55 - EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL =
2
PARCEL INFORMATION: -i
PARCEL NUMBER(12 DigitNumbcr) 22301 --7 C.,- IN 13 a ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT 2. r
SITE ADDRESS 7(6 A/L L SG(t^;A)G Pr- CITY -e)rC.t Yew-L.,
• DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO❑ SNOW LOAD: psf
. IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Chcck all harapplp):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW/1 ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage Commercial Bldg,Ere)
IS USE: PRTMARY/FS SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Pan(:j ofBldg)❑ NO❑
DESCRIBE WORK Mu/ DP.}�‘tniel ' i ct,AI,
SQUARE FOOTAGE:(proposed)
1ST FLOOR sq.R 2ND FLOOR sq.ft 3RD FLOOR sq.ft BASEMENT sq.ft
DECK sq.ft. COVERED DECK sq.ft STORAGE sq.ft OTHER sq.ft.
GARAGE 611 sq.ft. Attached❑ Delached)X CARPORT sq.ft Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: • *4 COPIRS OF THE FLOOR PLAN REQ1JW [)*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: �/
SEWAGE/SEWER SOURCE: SEPTIC QQ ❑ / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES❑/ ` NS !" Ifyer,attach completed Water Adequacy Form
I PERT ETER/FOUNDATION D S PROPOSED? YES NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 0 TOTAL BEDROOMS "D •
OWNER acknowledges that submttss n of Inaccurate information may result In a stop work orderor pen t revoabon.Acknowledgement of such is by
signature below.I declare that 1 am the owner and I further declare that I am entitled to receive this permit and to do the wa-k 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
rep:rse,dative,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 permttlappfcation becomes not&void if work or authorized constructon is not commenced within 183
days or if constriction work is suspended fora 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 14.0&42)
x I/i1-17-3
rSignature of OWNER(Must be sinned by the OWNER) Date
:13FPARTM)ENTAL RL'eVI W'=- ;=APPROVED `= DATE :s DENWTI:i.•::DATE .TAGSfNOTES/CONDITIONS 4
BUIIDING DEPARTMENT ,
PLANN]NG DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH k _( "I'tL _Cc IciA :1
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