HomeMy WebLinkAboutBLD2023-00154 - BLD CD Environmental Health Review - 2/6/2023 ' L. MASON COUNTY COMMUNITY SERVICES Permit NOO I a2OZ3 —6015/
' ^Y PERMIT ASSISTANCE CENTER:
( � •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL /� ^
` I _ 615 W.Alder Street,Shelton,WA 98584 /aX n (l i,/��
7 Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
Belfair(360)275.4467•Phone Elmer(360)482-5269 F`:J
BUILDING PERMIT APPLICATION 675 (f, 0V 9r,
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: "1/ry
NAME: K2ED 4 v)€II i)``I r J ICI NAME: IV<.a r 1-40 ME }S G ILL)t=7.12- S' Sit.
MAILING ADDRESS: CI 0'a 7— 19,(,1 (L..''1 % ) MAILING ADDRESS: PC), 60X 722 et
CITY: -iff afs)f'IL' STATE:�.ht ZIP: cif to CITY:CIZAt9E J 1 f:vJ STATE:WA. ZIP: 9 s61(
PHONE#1: '7 ,y4,.11 I:y .- 1 T,,L`-? PHONE:31v>a-$tf(J-4/9410ELL:
PHONE#2: LI'9 -. "; 7Lt,--i EMAIL: N4S1,1}i0AnC Pon 1!Mf 1"2,S@G1NA1L
EMAIL: 1. CL-C:)> •et >`v' e Gm:i (c w,n L&1 REG# ErV 6'N-M E N TA L
PRIMARY CONTACT: OWNER 0 CONTRACTORZ OTHER❑
NAME EMAIL REACH
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 21,00 L —II --�0 2 9 0 ZONING
LEGAL DESCRIPTION(Abbreviated) CI L 13 Qt'"av� NE z t\J-2v ' FIRE DISTRICT
SITE ADDRESS 1 C 4 E. COIM M to IN 1 C e-H A a(o,, CITY c)-I F L T T IJ Q►%ra r0'14
DIRECTIONS TO SITE ADDRESS 2.rm m1 L F S rQ&3__cd-.7_ .&7 TJ4 t/_V'3 tit
PICK.c...(2.Iv,-1cn RQA0 . L-EEf'a___SJIs/_ P., -CDa ' A11 '`/ c-1-uG Rr ,,
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO.K SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apple):
SALTWATER LAKE 0 RIVER/CREEK❑ POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITIONS ALTERATION❑ REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence.Garage.Cnnwrerciul Bldg.Etc.) P.,1~c 1 V,iwy<.((`,r .
IS USE: PRIMARY❑ SEASONAL 0 NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whale Blagl YES(I WO)of Bldg)0 NO 0
DESCRIBE WORK w 6°'�6IC3 • SP4 r 3 IKE,610 f%.(41-- /S11-.I le(X)W 4 /C-J' C.t:3.14
SQUARE FOOTAGE:(proposed) 'ifi ammo
1ST FLOOR 4J b.6 sq.ft. 2ND FLOOR.41 y 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❑ Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: eAf 1rGti1gtd i ROOMS
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / ''NEW❑ EXISTING; )
PLUMBING IN STRUCTURE? YES lit NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOM EXISTING SQ.FT.
EXISTING BEDROOMS 3 PROPOSED BEDROOMS_.3 _ TOTAL BEDROOMS ?s
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 at 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 8 void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 160 days.
PROOF OF CON INUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APP CATION OF 18 AYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X .—....-"4---- /2/z ,/2z
--••S nature of OWNER(Mine signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH 4-r zp,w77 Ct 1 t l\-•5 (1-
4-
a
�o
_. __ _. ._.. _ !.. .- e.CommtJNf•Y .::LU6 40fi[l
42 Ju ,.-.'
9 '
4._?I ---.).i LArEK:P;: CNN Cr0
Qe<tftvf Pius FrcL03
nf 1 II
LA7dI L$ (,r ,.■_;
4b'
I
Vis l,ki i
two.,L Pr".r.n,./E. rA n7 t=
4.
,,,0
it,-,P,.
0
i
i f0't,
i E .cr'J: I1.u:C
t `_EY S7 .R, 7£CC.
Sid/o23 -5o154f f
fob.
4S'
g 6utx11.<an
o@
$g a LU O 51
`cc . RECEIVED
se e=gram s@
a FEB 06 2023
V03 'I E o m Q r
w = �. 615 W.Alder Street
U) g No
I ram
A
LQ 2 i.a PLL:.:- PLAN Ar,.EI, "22oQ4 Ii. ,
2mm c;f. Rcduta.& 1.1t5
ms�te.8
amtioo£
Iaylde ) dney
um-R.,_ TT /1 1
j 1� ,
�/ ////// Pi/ ; I/ //,/j j, 1/1, ; / B-Line Construction & Excavation
///
///0-1`c
/ I
{ \.5 gg F,5 • 1 , f if
gl -- 4do ✓,gar- "al?t.
i _—
r / i__ _L,2_7,mqvc, _ ______
GIs,
t ,che1
/--v,'J7fi _ — _ - 00�;/- as28.0
4 \d/AzolAq lvai- 173' 5e/ile--
/'
nine 0/+ :%2i��,dL?�';�;r1 :`D'f.
keses•Je_
't-9. „__ - _ALL
J,, dre.:, e L lu `era1S w', fir,
to f — — — — kb duVe.� \ 1 c,
kz-21f---4----(19-1--#02, - 4."2-1 4( t
r, -- — — —16 5 1I
— — — -- _ 1
i
} 44 . 42,
/ t .
//---- — i ......._ ..,___ i L ___ ___ '
NORTH
��rrilN /Iiz / ?/a,42i'
. .
•• .••
- • _ . _
m
Z
a).
....k. <
01 73 = X
rn M 0
0 > 7
•-•1 IV = M
CZ <
zC.A.,
III
-I,
.....
--I
CD
CDM ...1-.'
f.' 4-..
4^
= .
s.
1 --I
I r
f• Zi
+. .••C
Z- .
Ei II:11.-:-...-..- ar---•.....--.z.-- --1--
I-
0 A.. vl
? A .• 0
-I
.Z c .
44, F.
:4
II
..•
'1 44
0- --4
=
\\--.
' A
11
f:
I F.LIC,
i
1‘
ii
....0
.
1. .
r-
Z .
—.
rsb Z.
x..:
„.1 —
6 .
. c7.
a;i i
•
i o
•- o
•
...•
...t.
44 4••••
IL
-..1...._
IZZ)-7-.1
I tt`
•
' .
;i V
II
••k( ! 1
4
i V
li
......
14..
a"..
.4... 3'1
it
•
-.. , ...,.
o• ..-
.11111•11111M,
. .
•
. .
•
•
•
----.-.-- - --_
55
F
, m
o
m
I< ri.
i
P
c• 4,,,c- -:,.
.,r
;
2. re.
%7
ta
C
vl
5' 70 to
70
12,—
.1 . .
...
• .
•
i •
t
1 -
r.
,
........„
0:,
, . Bc„. ,
c-i
------b'ai
< -g
. .
•
. .
II•••••••••• •/.....1111MMIMMINI ___
-......___