HomeMy WebLinkAboutBLD2023-00144 - BLD CD Environmental Health Review - 2/2/2023 n
�,„ v'''''''''4.t;i^ MASON COUNTY COMMUNITY SERVICES Permit No: 131 11 nl):%;�I- obi-1-1
z PERMIT ASSISTANCE CENTER:
. •BUILDING••PLANNING•PUBLIC HEALTH•FIRE MARSHAL RECEIVED
3 615 W.Alder Street,Shelton,WA 98584 ^ /�J�
o �' V
G. , Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
1'1?16
" Belfair::(360)275-4467•Phone Elma:(360)482-5269 FEB 0 2 2023
BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY
OWNER INFORMATION: CONTRACTOR' J
INFORMATION: .
NAME: Oa()/Q/ Ja/� 1S S NAME: v Q�� (
MAILIN ADDRESS: /76,23 /a,:6erygSat/MAILING ADDRESS: Z
CITY:Kai/te_ttiy STATE: /el ZIP: qr. ' CITY: STATE: ZIP: Uu =
PHONE#1: (46.-7%-_ V7 PHONE: CELL: f"•
PHONE#2: EMAIL: Z
EMAIL: dri).Gd/17/1 an5my 1,!,/yll17!`rii7 L&I REG# EXP._/0 J
PRIMARY CONTACT: OWNER 13" CONTRACTOR 0 OTHER 0
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP_
Z
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) ( /%Q L/ //- y,e)0/O ZONING
LEGAL DESCRIPTION(Abbreviated) . Q-#3/y/41,4" P&,9q FIRE DISTRICT
SITE ADDRESS C i -- - J-' CITY f
DIRECTIONS TO SITE ADDRESS S' 0 / - c •
J ear ca7/D Sc iSS :rr�� 'M 7 3' �i 3 tQ/ /�tr�/aa �f.f� Ca? 1'i f f
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): •
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW Er ADDITION ❑ ALTERATION❑ REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) R(I;5; /]LAG)
IS USE: PRIMARY I SEASONAL 0 NUMBER OF BEDROOMS / NUMBER OF BATHROOMS 3
HEATED STRUCTURE? YES(Whole Bldg) ( YES(Part[s]of Bldg)0 NO 0
DESCRIBE WORK et J '/ biz /QG i -1
SQUARE FOOTAGE: (proposed)
1ST FLOOR o?) ') sq.ft. 2ND FLOOR 49 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK /0 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE /61O sq. ft. Attached(Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC( SEWER❑ / NEW EXISTING 0
PLUMBING IN STRUCTURE? YES Er NO 0 If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS y 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
PE T APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X �/uL7J3
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 _ (�'�
PUBLIC HEALTH P.1' I etzz1z 5 CCUNZ 4\CA„.S ;.C��E'� 1
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