HomeMy WebLinkAboutBLD2023-00131 - BLD CD Environmental Health Review - 1/31/2023 snv'c'n''w1 MASON COUNTY COMMUNITY SERVICES Permit No: GO ao a 3- 00 f 3 6
o PERMIT ASSISTANCE CENTER: r( • �j
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.�Z i •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL "� t�... Lr..I . ►=Li
•�I. 615 W.Alder Street,Shelton,WA 98584
y' "'� Phone Shelton:(360)427-9670 ext.352-Fax:(360)427-7798 Phone /),1 JAN 3 1 20'J
iy - - a� Bel/air(360)275-4467•Phone Elma:(360)482-5269 r V
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BUILDING PERMIT APPLICATIONtJ15 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
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NAME:Keith Stephenson NAME: E I V V I R O N MEN T A B
MAILING ADDRESS:1737 Gregory Way MAILING ADDRESS: �1
CITY:Bremerton STATE:WA ZIP:98337 CITY: STATE: ZIP: H E a LT H
PHONE#1:850-786-7940 PHONE: CELL:
PHONE#2: EMAIL:
EMAIL:keithstephenson@bellsouth.net L&I REG# EXP. / /_
PRIMARY CONTACT: OWNER 0 CONTRACTOR❑ OTHER 0
NAME Kathstehrrson EMAIL keithstephenson@bellsouth.net
MAILING ADDRESS 1737 Greogry Way CITY erarrerton STATE WA zip98337
PHONE 850-786-7940 CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number)22116 77 90041 ZONING RR
LEGAL DESCRIPTION(Abbreviated)TR 4-A OF SURV 15/194 TR A OF SP#2350 FIRE DISTRICT F.P.D.05
SITE ADDRESS 10 E Keyhole Ct CITY Grapeview
DIRECTIONS TO SITE ADDRESS From Shelton.WA lead North on Hghway 3.turn left on Anthony Dr.for 2 rodeo and then turn right on Keyhole Ct. .
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 144/e: YES❑ NO 0 SNOW LOAD:3CW 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❑
TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION 0 REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)Residence
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS 1 NUMBER OF BATHROOMS 1
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Fortis]of Bldg)0 NO 0
DESCRIBE WORK
SOUARE FOOTAGE:(proposed)
1ST FLOOR437 sq.ft. 2ND FLOOR 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 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKESkyline MODELF850CT8 YEAR2023 LENGTH32feet
WIDTH t3 ore'8 inaee BEDROOMS 1 BATHS 1 SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER 0 / NEW 0 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 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 8 void if work or authorized construction is not commenced within 180
days or rf 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)
Signature of OWNER(Must be signed by the OWNER) 1 Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
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