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HomeMy WebLinkAboutBLD2023-00123 - BLD CD Environmental Health Review - 1/30/2023 Alook 0yv�'"''`'t-4:1,4 MASON COUNTY COMMUNITY SERVICES Per t �� ��O �l) -00i�� ) PERMIT ASSISTANCE CENTER: �E D `' ° BUILDING•PLANNING•PUBLIC HEALTH.FIRE MARSHAL S a'• � ?1�'r ,�y r 615 W Alder Street,Shelton,WA 98584 y f . Phone Shelton:(360)427-9670 exL 352•Fax:(360)427-7796 Phone /)/ \ AN 3 0 2023 3� ^;y�. Bellalr:(360)275-4467•Phone Elma:(360)482-5269 (/ g.trlre9t BUILDING PERMIT APPLICATIO1%615 W. Alder Street PROPERTY OWNER INFORtMATION: CONTRACTOR INFORMATION: M NAME: 13 rr j:. ' )1 e,.t,..:j L�s� NAME:1,14 11%/5.67 1/ s . (e,vier Z MAILING ADDRESS: s.. '�V1,: 41 l„� ). MAILING ADDRESS:f,l k ort p,,r..oa - CITY: t',‘4(k W.v STATE:\n),A ZIP:c-l-")71 CITY: A,t 1 1-r.t4 STATE: 1./S LIP: ei 7h' = PHONE r1: .3 f j J - ?:�?, :4�,1- t,,D.45`3 PHONE: 3E0-'7;7- 6(4 7 CELL: m O PHONE#7: 15•4 -27 :/.7- Ir: )9 •1 EMAIL: to•n, 12:rit ,hI/ e_ wt,s144croe•Co:m EMAIL:d Si i u:,;c l()h.!(Ai/cc f r b<) 1--d' ((1-L&I REG# 1-1 17 2 7 EXP. i( /3)/ 2.3 > zz PRIMARY CONTACT: 1 OWNER 0 CONTRACTOR❑ OTHER 0 E NAME EMAIL = m MAILING ADDRESS CITY STATE ZIP Z PHONE CELL ' ''l PARCEL INFORMATION: PARCEL NUMBER(I2 Digit Number) ^•2)-16 - S 2 0 tr f Z Z ZONING LEGAL DESCRIPTION(Abbreviated) L.7 j- 12 2- bi,'z r I. sr,,ncn A/. I?FIRE DISTRICT SITE ADDRESS )z 1 tJ 1 r'('L. l-o in t CITY I•kn1S pn/'{- DIRECTIONS TO SITE ADDRESS IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO 13 SNOW LOAD:9 5 psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that aspic): SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0 TYPE OF WORK: NEW 13 ADDITION❑ ALTERATIONp ❑ REPAIR 0 OTHER 0 USE OF STRUCTURE(Residence,Garage,Conunerrial Bldg,Eie) !144" 7 irkt' i c. ;(ems c t• IS USE: PRIMARY 0 SEASONAL[1}" NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS L HEATED STRUCTURE? YES(note Bldg)E' YES(Parr[s]ofBldg)❑ NO❑ DESCRIBE WORK fi ,J s f ,)i-G elv;c.e( ( -rte. i h:Y c f' SQUARE FOOTAGE:(proposed) 1ST FLOOR 152-`f sq.ft. 2ND FLOOR " sq.ft. 3RD FLOOR - sq.ft. BASEMENT sq.ft. DECK sq.ft. COVERED DECi sq.ft. STORAGE - sq.ft. OTHER sq.ft. GARAGE - sq.ft. Attached 0 Detached❑ CARPORT - sq.ft. Attached 0 Detached 0 MANUFACTURED HOME INFORMATION: I v *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE A-- �i)34Cr7 !'K'rn e. MODEL f%nt It v/31' (i b--- YEAR a- ' LENGTH S t'LI't WIDTH ZG'- tS" BEDROOMS 2— BATHS 2 SERIAL NUMBER 2.52 3 i<IV '7'1/t; ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC x� SEWER❑ / NEW Er EXISTING 0 PLUMBING IN STRUCTURE? YES 0 NO❑ If yes.attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT. -- EXISTING BEDROOMS -" PROPOSED BEDROOMS 2- 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 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) /D /cam X ( ()a 7 Signature of OWNER(Must be signed by the OWNER) alk DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE• TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH V A 211 fej1 i flf f(o6' 'I w ik(Lryi(1 furs.; EH SETBACKS A)Drainfield/Reserve requires 10'setback from footing/foundations 13)Septic tank(s)requires 5'setback from all footing/foundations D 1 'A C)No foundation/perimeter drains within 30'down-gradient of drainfield/ 0n /1• _D i/�t,I 1<,/ly! J reserve area ri V C 1 �J v r` D)No cut(s),bank(s)(greater than 5'&over 45 degrees)within 50' down-gradient of drainfield/reserve area c H )1 r/2 1 U. r —1 • /�/) I EH APPROVED C� cJ rT (�C D.Mdason 02/24/2023 I 1l . rvx k- L Cun 1 E ' 2O2,3- CC) la a .kD Eb y, Io5 i3 .o - - - __--r - - lie _75 r -' ` — 3�f- -' .h EH Waiver sited _ — 3v}E iS �_. reducing fro 10' min Cc mart tin � 10' min" �•- - min 11111, p S' rhF `� T� 6� c �1 f MF \ 1....1.,.. i IJIC- 4V4111- fjc o' min 0OC AIL_ 3I . \ \•., r v rf _ 2,0 �I ' - `35' 1 ......� 3 3 3 3 13 n.0 0 —I44 3- -", co 11) 3 3 3 I fsc:,�ed N 3o a 3b3ZI V y m 3ax40 a) N N _ Nic, Si dG_ ,< _ ,.2 .i 0 S 0 0 0 s • 3 N -.—i . ® *' .._ \/ Qsy to i /\ p 1 0 -' 3 •-:--,---3 -r ,-r-, •- A5rik';'44.°11.1.1. I, 16 sue:-_. i • • r — �Ell s... �1 �1 t 11tr 1� 1 1. r , .u, 41. Zill � r ©per®`,�. 1 1{. ,S i r r < 1• .,t. . N ® i r _ kr {'� ,` L. I. 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