HomeMy WebLinkAboutBLD2023-00037 - BLD CD Environmental Health Review - 1/12/2022 (-...---EICT:: Z//9
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MASON COUNTY COMMUNITY SERVICES Permit No: �`►•
1 ;0,,_
' .\ PERMIT ASSISTANCE CENTER: :` ` �1
r` •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL JJ
(. .,, 615 W.Alder Street,Shelton.WA 98584 � , , a
'? Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone 61 C { 204
\: Bel/air.(360)275 4467•Phone Elma:(360)482-5269 c ��/ kie
BUILDING PERMIT APPLICATION
62oG� r Street
PROPERTY OWNER INFORMATION:. � CONTRACTOR INFORMATION:_ 0003/
NAME:G . C Si-rad-LA 141C.- NAME:_
MAILING ADD ESS: MAILIs1'
CITY:Sl STATE: E, ZIP: CITY:.
PHONE#1:' • • - `7% • PHONE: ENVIRONMENTAL
PHO •2: C)•- cr t,--6 'L EMAIL:_ ((�� 7�-�j
EMAIL".. . v (a ' A ' 't t.tt L&I REG-i* H E�rl
PRIM Y CONTACT: OWNER I� CONTRACTOR*.-� OTtl p a, �-, LL� , co �
NAME � S� (V,S EMAIL Alta C h.i7),vlte 108 + 'l'`�^-t/
MAILING ADD�ES C� "JS I/d`e-J P1 CITY if• -91.-- STATEd.AJOt ___ :� 7L
PHONE Shp^D —O`-_S'Z CELL lil —i / r- / /
PARCEL INFORMATION: ) CJ O0F,
PARCEL NUMBER(12 Digit Number) L j.2-a I r' )/— 900 V ZONING i$
LEGAL DESCRIPTION(Abbreviated)/' I of ' 40 j'%/1]of l L It DISTRICT
SITE ADDRESS U'-W, C • CITY f •
DIRECTIONS TO SITE ADDRESS tt tM J. - •
/ h < e-
Cl fp 7B - 57 Sr en&-,A eS— j I A KC,• (-51- If-17144- A '4^C P fdri.^. Cylorc. er N i'Pj ?✓`<
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: (Check all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW : ADDITION 0 ALTERATION` i ❑ REPAIR
�❑ OTHER ❑
USE OF STRUCTURE(Residencegle5 ,
ammercial Bldg,Etc.) ► -C-4—'T S" t44'
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)C`l.,� YES n/s)ofBldg)❑ NCO �-1
DESCRIBE WORK �Q Z v►d �Ioo vr1
SQUARE FOOTAGE: (proposed)
1ST FLOOR 9.Z sq.ft. 2ND FLOORQ 36 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE _sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached 0 CARPORT sq.ft. Attached 0 Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE M YEAR LENGTH
WIDTH DROOMS BATHS
ENVIRONMENTAL HEALTH: 5/1 20 22—005 7 7
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ I NEW EXISTING 0
PLUMBING IN STRUCTURE? YES NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOD EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS D TOTAL BEDROOMS
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
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 APPLIC TI F 180 D F MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
UNTY CODE 14.08.42)
signs ure of OWNER(Mus be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL n fr / �'J
PUBLIC HEALTH O) 2( 1 n (61?(1t 1(c f7S 0(�G(LG'
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