HomeMy WebLinkAboutBLD2023-00160 - BLD CD Environmental Health Review - 2/8/2023 0 $` '`'ty MASON COUNTY COMMUNITY SERVICES Permit No: ��' �0��� oD��O
trillb 7 PERMIT ASSISTANCE CENTER:
((((' ,t,•BUILDING.PLANNING•PUBLIC HEALTH•FIRE MARSHAL ,,�/
)�• 615 W.Alder Street,Shelton,WA 98584 �SX�
Phone ShaRon:(360)427-9670 ext.352•Fax:(360)427-7798 Phone �A ' \ -C. �,
f Bellair.(360)2754467•Phone Elms:(360)482-5269 / \ LI
BUILDING PERMIT APPLICATION �/
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PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: r(' fin?;
i� I�,
NAME:Patricia Kaman NAME: 1 °V V. A TerMAILING ADDRESS:Po Box 1297 MAILING ADDRESS: Sirs
CITY:A11yn STATE:WA ZIP:98524 CITY: STATE: ZIP: i et
PHONE#1:360 304-2023 PHONE: CELL:
PHONE#2:360 5525135 EMAIL:
EMAIL:KermanpooleQgrnail.com L&I REG# EXP._/ /_
PRIMARY CONTACT: OWNER Q CONTRACTOR 0 OTHER 0
' //Q
NAME PatKarman EMAIL KarmanpoolerDgmal.com VA,
MAILING ADDRESS Po Box 12s7 --- CITY A0Y STATE WA Zip 98524f°5/<<\,1
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PHONE nc land in. CELL 36o3o+-2°23
PARCEL INFORMATION: i-,5, 44`w
PARCEL NUMBER(12 Digit Number) 12229-440005110 7ONINGRR5 �/`
LEGAL DESCRIPTION(Abbreviated)PCLC+T,L,of BLA#01-46 FIRE DISTRICT 3
SITE ADDRESS 141 E.Nelson Rd CITY Mir,WA
DIRECTIONS TO SITE ADDRESS Grapeview Loop Road to East Nelson Road.100 yards on East Nelson Road to driveway on left
sign with'141•at driveway entrance
IS THE PROJECT WITHIN 300 FT OF SLOPEtS)GREATER THAN 14%: YES❑ NO Q SNOW LOAD:: f
IS PROPERTY WITHIN 200 FT OF THE FOLLOWLNG: (Check all that apply):
SALTWATER 9 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
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TYPE OF WORK: NEW 0 ADDITION Q ALTERATION❑ REPAIR 0 OTHER (I
USE OF STRUCTURE(Residence,Garage.Commasial Bldg,Etc)restdential
IS USE: PRIMARY❑ SEASONAL 0 NUMBER OF BEDROOMS° NUMBER OF BATHROOMS°
HEATED STRUCTURE? YES(57wte Bldg)0 YES(Parr/a)ofBldg)0 NO❑
DESCRIBE WORKSIurfio connected by breezeway to house
SQUARE FOOTAGE:(prnpnscd)
1ST FLOOR304 sq.ft. 2ND FLOOR" sq.11.. 3RD FLOORna sq.ft. BASEMENT" sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.tL OTHER sq.ft.
GARAGE sq.It. Attached❑ Detached❑ 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 0 SEWER 0 / NEW❑ EXISTING D
PLUMBING IN STRUCTURE? YES 0 NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUND ATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.1C40
EXISTING BEDROOMS 1 PROPOSED BEDROOMS 0 TOTAL BEDROOMS 1
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 alt 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 fora period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT_A. PLICATI OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X January 31, 2023
Signature of OWNER(Must be signed by the OWNER) Date 1
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL /f� J
PUBLIC HEALTH 0/1 2t1 2'?i &'ndi tcnj t(/(,(�'C1
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