HomeMy WebLinkAboutBLD2023-00060 - BLD CD Environmental Health Review - 1/18/2023 •
•t•1,.• MASON COUNTY COMMUNITY SERVICES Permit No:( L O C)�J-�O b(9
` PERMIT ASSISTANCE CENTER:
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL �['•��' ri `.I'�'
1 I• = 615 W.Alder Street,Shelton,WA 98584 Rf.•�C E I y t�L,J
f .,,- Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone /A
Belfair:(360)275-4467•Phone Elmo:(360)482-5269 JAN Ai 1 1t '1 =`1 , _ I `
BUILDING PERMIT APPLICATION
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PROPERTY OWNER INFORMATION: CONTRACTO ORMATION eet:
NAME: -+ T KA , York Enterp es:�i �P ON M E N TA L
MAILING ADDRESS: 1 ]( C 140( ��(' E
, 3517 S.13th Strcct H LT H
CITY: �� S ATE: ZIP: Tacoma,WA 98405
PHONE 1: to,41 - ZI 5 (.14]? i 253.752.3189
PHONE#2: —
EMAIL: ►Y1(1ttaYbl.S inaEi,(..0)VVI YORKEE'968PR Remodeling Specialists Since 1979 /_
PRIMARY CONTACT: OWNER 0 CONTRACTOR❑ OTHER Er
NAME y.]Te D QC'41C-1).( _Lif. EMAIL e* Q V 1- wAAtt •C�IM
MAILIN�/qA�DDR,ESS J 5 1� '�" 4 g CITY GtQAF(A ' STATE((A IPeIe6$'3c,
PHONE r:�7�•.4BI• ezaSLiel CELL
PARCEL INFORMATION: 7� /� !
PARCEL NUMBER(12 Digit Number) '(,(n/LL Z' 5J(e7 - colz) (n
, ZONING
LEGAL DESCRIPTION(Abbreviated) 'Q•Q`* cat,n. ¶.P t'12 > t TVIIIRE DISTRICT
SITE ADDRESS 1lb2GI I E MP( IP( CITY 1-FPn9-
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO d SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER lie LAKE 0 RIVER/CREEK❑ POND❑ WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW V ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) //
IS USE: PRIMARY d SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS 'L
HEATED STRUCTURE? YES(Whole Bldg)I. YES(Part[s]of Bldg)❑ NO 0
DESCRIBE WORK
SOUARE FOOTAGE: (proposed)
1ST FLOORL't sq.ft. 2ND FLOOR------ sq.ft. 3RD FLOOR .— sq.ft. BASEMENT — sq.ft.
DECK 1,1(V( sq.ft. COVERED DECK lQ ) sq.ft. STORAGE - sq.ft. OTHER sq.ft.
GARAGE ,.....----.....sq.
/sq.ft. Attached❑ Detached❑ CARPORT /r sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: J
SEWAGE/SEWER SOURCE: SEPTIC N� SEWER❑ / NEW NJ EXISTING❑
PLUMBING IN STRUCTURE? YES Er NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ n NOS' EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS L- TOTAL BEDROOMS 2
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 parties,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 if work or authorized construction is not commenced within 180 i
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
COUNTY CODE 14.08.42)
X
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL /� r/�y, ) /��,/�
PUBLIC HEALTH J A .3/073 CCnCll'{'�i�&Ida
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