HomeMy WebLinkAboutBLD2023-00139 - BLD CD Environmental Health Review - 2/1/2023 �,,og c P�t pp(?
4�4 MASON COUNTY COMMUNITY SERVICES Permit No: �
PERMIT ASSISTANCE CENTER:
•BUILDING••PLANNING•PUBLIC HEALTH•FIRE MARSHAL
4 >� I' • 615 W.Alder Street,Shelton,WA 98584 RE L,L I v i i r 4. 2((f
YGt` Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone r
Ojn dy Belfair:(360)275-4467•Phone Elma:(360)482-5269 I"tB — 1 2023
I(b•t1.L1v-AN''
BUILDING PERMIT APPLIC�►oTL F cjer Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Eric Aasness NAME: +VI RON M ENTAL
MAILING ADDRESS:PO Box 58782 MAILING ADDRESS: H EA "
71
CITY:Tukwila STATE:WA ZIP:98138 CITY: STATE: iR
PHONE#1:206-915-3742 PHONE: CELL:
PHONE#2: EMAIL :
EMAIL: L&I REG# EXP. / /
PRIMARY CONTACT: OWNER CONTRACTOR 0 OTHER 0
NAME Eric Aasness EMAIL eric.aasness@homebridge.com
MAILING ADDRESS PO Box 58782 CITY Tukwila STATE WA • ZIP 98138
PHONE CELL
• PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 42223-50-00038 ZONING R5
LEGAL DESCRIPTION(Abbreviated) Potlatch Beach Tracts TR 38&TL FIRE DISTRICT 1
SITE ADDRESS 22710 N Hwy.101 CITY Hoodsport
DIRECTIONS TO SITE ADDRESS Go North on Hwy 101,22710 Is on the right(water side)just leaving Potlatch.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO 0 SNOW LOAD:25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE ❑ RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW ❑ ADDITION ❑ ALTERATION Q REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)Residence
IS USE: PRIMARY ❑ SEASONAL 0 NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole Bldg) ❑ YES(Part[s]of Bldg) 0 NO 0
DESCRIBE WORK Alter existing residence to create a residence and ADU
SQUARE FOOTAGE: (proposed)
1ST FLOOR 332 sq.ft. 2ND FLOOR 166 sq.ft. 3RD FLOOR sq.ft. BASEMENT 624 sq.ft.
DECK 101 sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE 270 sq.ft. Attached 0 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: V4 U? Z DWI)
SEWAGE/SEWER SOURCE: SEPTIC ❑✓ SEWER 0 / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES ,r❑ NO❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOB EXISTING SQ.FT.
EXISTING BEDROOMS One PROPOSED BEDROOMS One TOTAL BEDROOMS Two
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)
X • 0 / a3
ignature f OWNER(Must be sinned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH gCr 5107/ c c 4)-1 )S ckojQj
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