HomeMy WebLinkAboutBLD2023-00188 - BLD CD Environmental Health Review - 3/15/2023 Oft
. a�"� MASON COUNTY COMMUNITY SERVICES Permit No:31dLOl3 -00IS&
_ PERMIT ASSISTANCE CENTER:M �tr�
-,� •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
ER DEI
'4 I. •o 615 W.Alder Street,Shelton,WA 98584
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�J, rte Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone [ 202 .
- - Belfair:(360)275-4467•Phone Elma:(360)482-5269 J 3
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BUILDING PERMIT APPLIC• ION RECEIVED C/V,��
PROPERTY�, DOWNER INFORMATION: CONTRACTOR INFORMATIO BAN 1 3 ?d
NAME: f!.f R'A aY 4' N t• i7Lu.�L� C L t NAME: Vl ji 615 I n' ?.3
MAILING ADDRESS: I")c/(� +rY�.2 , ILING AD�IRESS: ✓V A •
CITY: l/t1Q1 u� STATE: l_I1'�ZEP: n( 1 CITY: STATE: ZIP: der Stye
PHONE#I: (.0 e • PHONE: CELL: et
PHONE#2: ' "- .7. EMAIL: r
EMAIL: L&I REG# R.aLMC A 1 g7.110 r EXP.d%Jf' 2-3
PRIMARYCONTA T: OWNER ONTRACTOR j OTHER❑ '�1 ,/e �/
NAME J 1 &.. ( `/ ST/"2 EMAIL r / 1.-' IA)y ei 5 K. a, G 1
MAILING ADDRESS I74'L Fey-rLrT S "f3 CITY LLLtL U.P t STATE `01 _ ZIP te'L ' V
PHONE / O1/ 74 I aT_' CELL
PARCEL INFORMATION: / �; /J,y6
PARCEL NUMBER(12 Digit Number) J�l 7�' "r ce T 4, C ?/ ZONING JAI s7 A.: Z
LEGAL DESCRIPTION(Abbreviated)f rI I� p A.,&.L eqe A/,471O7WE'ISTRICT
SITE ADDRESS , I y
DIIiECTIONS TO SITE D //Cl �// qj �14
• -1[ YR. i{t,4. f- c ./cam/t 4,'i3 b►'
-
IS THE PROJECT WITHIN 300 FT OF SLO )GREATE THAN 14%: YESO 0 SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF I HB FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NE ADDITION❑ ALTERATION❑ REPAIR 0 OTHER ❑ ENVIRONMENTAL
USE OF STRUCTURE((! Bence,Garage.Commercial Bldg,Etc.) ii4,,f ie j , f/0...e H EA LT H
IS USE: PRIMARY 6 SEASONAL 0 NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(whole Bmgi.e (Part(s)oj�Bldg))0 NO 0
DESCRIBE WORK !�L J ��o - � .
C ,e/t� ^mil rl4,/./
SQUARE FOOTAGE:(proposed)
1ST FLOOR f i Ift 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 50 sq.ft. Attached'Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME LNFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWERCY / NEW. EXISTING 0
PLUMBING IN STRUCTURE? YES' NO❑ If yes,attach completed Water Adequacy Form O t...` L.
PERIMETER/FOUNDATION DRAINS PROPOSED? YES`[]' NOD EXISTING SQ.FT. -19'•
EXISTING BEDROOMS PROPOSED BEDROOMS "" TOTAL BEDROOMS Z
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 arrrss 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
Il
x ...Mil 2
re of OWNER(Must be signed by the OWNER) Date _....__.
DEPART t:_ TAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDLNG DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL �
PUBLIC HEALTH (3 I Lz7 �-( 'I)001/V5 `{'
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