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HomeMy WebLinkAboutBLD2022-01544 - BLD CD Environmental Health Review - 12/14/2022 i •�'�' ` 41, MASON COUNTY COMMUNITY SERVICES Permit No: {'2Ie-1 LU�-2 ". `5� PERMIT ASSISTANCE CENTER: i't/�-1 ' •BUILDING•PL61A5 KING•Street,SheC lton,WA IRE MARS4 a V Ire z o .,"4;."--.. ""*"''' Phone She!lon:(360)427-9670 ext 362•Farc(360)427-7798 Phone @r; - - - �r"t Belfair.(350)275-4467•Phone Elmer(360)482-5269 _, •, i .44. BUILDING PERMIT APPLICATION F.1 Y `n! .� Alder Street PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: 12) NAME: d i 7_ .f (1,0(Y-)�r �, i c n C` NAMI :CiYin a1'c Wet-(ll MAILING ► ��- ADDRESS: i r-t I (rtt_,I 0 i t W c' ( A 1%1 l" G ADDRESS: f,G,c A l�•-Fr . . T `i CITY:4fl i i.I t.•;t, STATEt t`4 !c-if`,4",�I "D t�ii,l tt...M_STATE:(j)-A ZIP: t P � PHONE#1: PHONE: CELL: _i PHONE#2: EMAIL:Kin rr'14,_Olio,/I.o*d) A i 712.�:GL6r JD( 1161110J) T ArT REG EXP. / / PRIEMA Y CONTACT: R-p—"-CONTRACTOR❑ OTHER NAME EMAIL ', • MAILING ADDRESS CITY STATE ZIP \ J PHONE CELL Q PARCEL INFORMATION: F— PA1WFT NUMBER(12 Digit Number).5 2C(`(2)-134 • tro. 1) ZONING w = LEGAL DESCRIPTION(Abbreviated) ,. FIRE DISTRICT ,.(/ 12_ SITE ADDRESS Ill 1,0 G% L1 n'1'p,L U t t~l l) le...--- crrY �_Ahk,F #CIft 2 DIRECTIONS TO SITE ADDRESS 1' Q IS THEWITHIN 300 PROJECT WITH 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO"SNOW LOAD:__psf • tlX�+ = IS PROPERTY WTIT�I 200 FT OF THE FOLLOWING: (CheekaE therapply): / SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF a STREAM❑ r Q TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION�S❑ REPAIR❑ OTHER S I cC•i.ilk ' ... W USE OF STRUCTURE(R'sideece,Garage,Commercial B7dg,Etc) .�f l �" IS USE: PRIMARY"SEASONAL❑ NUMBER OF BEDROOMS_ 1 NUMBER OF BATHROOMS •.•3 ,,y L BEA L'k t)STRUCTURE? YES(i'hol f Bldg)❑ YES(Palls)ofBld)❑, NO[} VI e-IA.%' J 3 DES("'BEWORTt lot r7e) J/� Ciiram-. Ex► i i�1L^ i'-1t � 4. I' AMI4-i ^l (- t .. " ' tx iTL f k.v�`r;L. %`7v 2 - 1 i • SOiJAkr:F/O'OTAGE:�ropo:� 1ST FLOOR ' GJ 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. Attnrhed❑ Detached❑ CARPORT sq.ft.Attached❑ Detached❑ • MANUFACTURED HONE+ INFORMATION: • *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE /' MODEL _�— Y.F.�R T FNGTH �H BEDROOMS BATHS SERIAL NUMBER_—___---- UMBER' —__f— ENVIRONMENTAL HEALTH: - SEWAGF/SEWER SOURCE: SE.YTIC, SEWER❑ / NEW❑ EXISTLNGEK PLUMBING IN STRUCTURE? YES,Er NO❑ Ifyes,attach completed Water Adequacy Form PERIMETER/FOUNDATIONDRAINS PROPOSisJ)? YES❑ NOe EXISTING SQ.FT. i EXISTING BEDROOMS PROPOSE.°BEDROOMS L.1 TOTAL BEDROOMS 1 OWNER acknowledges that submission of inaccurate information may moot In a stop work order or permit macadam.Acknowledgement of surd,is by signature below.I declare that I am the owner and I farther declare that I am entitled to receive this permit and to do the work as proposed.I have obtained permission from of the necessary parties,including arty 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 structrre(s)for review and inspection.This pemritlappfication becomes null&void 6 work or authorized construction is not commenced within 180 days or if annstru on 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 /S - c h-( . t.--\ i ZC(2 Z Signature of OWNER(Must be signed by the OWNER) D e _ :a, ..... -�....:.__. ._ _—s tea. ..: .• :._ ._:. -'r1. DKPARTT4 rdQTALREVIERr is;-_4T ROVRl):`�1 D ATRf. :sDEI�IED DATE'.-..TAGS/(VOTES/CO�IPTTIONS_. BUILDING DM'ARTMEINT PLANNING DEPARTMENT • FIRE MARSHAL PUBLICEALTE - ' ! 312I7-3 II C(Y\Ot1•( 4\.,t-t 4 • PRIMARY CONT CT 1 . OWNER ElCONTWICTOR2' O HER❑, NAME qj9C ` '�'""``.-- EMAIL° t: (Y Ar dc✓ 6 le-,I C�,S .4.w-�I MAILING ADDRESS CITY I'`5�11,,,,. STATE \&JP- ZIP465134 PHONE 346 • 63-7 CELL PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) 2,008 - 5 U 0 0 13 ZONING LEGAL DESCRIPTION(Abbreviated FIRE D STRI SITE ADDRESS `—,1, l 01. ,,,A ._.. V -0 r, CITY S DIRECTIONS TO SITE ADDRESS IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES El NO� SNOW LOAD: psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWA TER❑ LAKE% RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF❑ STREAM TYPE OF WORK: NEW 0 ADDITION' ALTERATION REPAIR❑ OTHER � rn...so,- S P so.. 1 /'0►-• ,Q 3 USE OF STRUCTURE (Res' ce,Garage,Commercial Bldg,Etc.) t O�/LU, IS USE: PRIMARY SEASONAL 0 NUMBER OF BEDROOMS NUMBER OF BATHROOMS HEATED STRUCTURE? YES (Whole Bldg) YES(Part[s]of Bldg) ❑ NO- �^ L DESCRIBE WORK S Vim- a Ai r 11 d" C 0✓1^rI� I N t— Y'e.VAc�✓..,I ►u.„ �u- SQUARE FOOTAGE: (proposed) " 1ST FLOOR) 'J 5 sq. ft. 2ND FLOOR .sq.ft. 3RD FLOOR sq.ft. BASEMENT sa.ft. I -f l,--tIr), 4i i L>f� DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq. e; GARAGE sq.ft. Attached 0 Detached 0 CARPORT sq.ft. Attached 0 Detached❑ O%L� /-, MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* `-c MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: • SEWAGE/SEWER SOURCE: SEPTI2)6 SEWER 0 / NEW ❑ EXISTING/ PLUMBING IN STRUCTURE? YES NO ❑ If yes, attach com leted Water Adequacy Form PERIMETER/FOUNDATION DRAIN PROPOSED? YES ❑ NO EXISTING SQ. FT. EXISTING BEDROOMS__ I PROPOSED BEDROOMS 1 TOTAL BEDROOMS i 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. perm lication becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspend or a period of 1 days. PRO F CONTI N OF WORK ON T S PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PE I PPLI A N OF 180 DAYS OF MO ESL CAUSE THE APPLICATION TO BE EXPIRED. (MASON U TY C DE 14.08.42) x ,/ \'-d1711627 Sign of R(Must be signed by the ER Date DEPARTMENTAL RE ED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH •I • (+00Awn m o a m a 0 i c a c �t ,o com a? m aNm =lD 7- o N n m R.v N -0 al o�°f ,a z O7.. .m fD 7' 0 N #J\ a 7 RI 41 91 StN Voco 1 v, .Z' N b - rF S 1SN„ 0 m a a g w 0.CDv m < ' 3 A N O N a 5 A o 0 o = ten Cr, ao3 U) 0 z N a o (.J m o $ N m N .. 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