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HomeMy WebLinkAboutBLD2021-01428 - BLD CD Environmental Health Review - 7/19/2021 L- l MASON COUNTY COMMUNITY SERVICES Permit No: PERMIT ASSISTANCE CENTER: - n .BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL -( F 615 W.Alder Street,Shelton,WA 98584 --` JUL 19 2021 _� Phone SheMon:(360)4273670 ext.352•Fax(360)427-7798 Phone r '� Belfalc(360)2754467•Phone Elma:(360)482-5269 BUILDING PERMIT APPLICATION 615 VV. Alder Street PROPERTY OWNER INFORMATION: CONTRACTORC� i INFORMATION:l NAME: IrCjr etc I VICi`y,�, _ a NAME: ' en c I 144)(42.s MAILIN AD{�{ : i Z: /Z ) MAIL G SS: et CITY: YIPf' _ ' ST fTE,'W ZIP: CITY: P►'l4 ��rr STATE: ti ZIP: YirS PHONE#1: _ rI 1�^ S PHONE tPI C L: PHONE#2:-- -__-- ------ — EMAIL II�I,/ i'►1G 1 1.CO of EMAIL: L&1 REG w/ V159 jj����/�t P.o41/Io/73 r C.C. PRIMA Y CONTACT. OWNER❑ CONTRACTOR❑ OTHER NAME 00 (c EMAILl!�YI I.5 to r• -, h�Sd�Cf 1‘t C3641,. MAILING ADDRESS A eck CITY y I�E� i f 4 STATE 'ZIP_ .0. PHONE .' CELL. INAPARCEL INFORMATION: y� r ,l PARCEL NUMBER(12 Digit Number) 3c3a.-V -.I ion( ZONING r LEGAL DESCRIPTION(Abbreviated) p vy _ _FIRREEyDTST ICI SITE ADDRESS F PO O UI I CITY — II ! DIRECTIONS TO SITE ADDRESS In / I D e • eu.:156'4(., IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO ck<NOW LOAD:3_e_psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ __J TYPE OF WORK: NEW ADDITION❑ AL)RATION❑ +REEPAIR❑ OTHER ❑ USE OF STRUCTURE(Reridence.Garage.Commercial Bldg.Ek.)__ { OV I^ I T rS c e nc e IS USE: PRIMARY�EASONAL❑ NUMBER OF BEDROOMS_,..2,. NUMBER OF BATHROOMS L. z a HEATED STRUCTURE? YES(Whole Bldg)"YES I(Part[s)of ❑ O❑ DESCRIBE WORK .-1V- it(J� �('-., Ii Ib�'iv P ©VI 19 fl a' p QZ SQUARE FOOTAGE:(pry,a rd) fff��� O LLI 1ST FLOOR Iq, p sq.ft. 2ND FLOOR _- sq.ft_ 3RD FLOOR _N.ft- BASEMENT_ sq.IL CC = DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft. \ GARAGE sq.ft. Attached❑ Detached❑ CARPORT _sq.It Attached❑ Detached / MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* z y� LL.J MAKE krars` 12____MODEL tf&Ce` y YEAR11) ) _LEN�G/TH �— WIDTH ✓l) BEDROOMS BATHS vr— SERIAL NUMBERC�RC-4 13 Z ENVIRONMENTAL HEALTH: SEWAGFJSEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTING W. PLUMBING IN STRUCTURE? YES g NO❑ If yes,attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO EXISTING SQ.FT. EXIS'ITN(i BEDROOMS 0` PROPOSED BEDROOMS _ TOTAL BEDROOMS OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement 01 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 parties,Inducting any easement holder or parties et Interest regarding this project the owner or legal representative,represents that the information provided to accurate and grants emproyces of Mason County arer,s to Ma above described property and structure(s)for review end inspeclon. This permit/application becomes null S 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 APPLICATI F 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY COUP 14.06.42) $Rjnature of O NER Mus signed by the OWNER) Date DEPARTMENTAL REVIEW . APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT — PLANNING DEPARTMENT FIRE MARSHAL / ��� PUBLIC HEALTH 'Lt q IL, Ch3n0k G-W`<O{""' a • O r • n r )4- <1. ,I..... ts_,g.. 70 r, w � o 3..- g 8 , ,:, --, i Cil)47.) 0 • -I --", ,v 88 841151 F.- —4 r 4 o 15) r, 0 iR CI ---- �' w a r t Z I it ^.r i.�J opp 9 W omomp - a ? O m -a D. c �z ccc . -. i o ��Qwn� , 1 sywv0, A- k‘t ji , m w -,-� .' O w m ( m m - . 4 01 TP (?_. 1 i:.4,..:>._. ri,...„.., • p — V/ _. co ww x , z 'C' _____a______ -...... v- S:. 33 a (i' • o = X" 0 w Q ao3 V) T ...477A jt 144,54,55- *WM° ? t1.own5e ictJ. ' I