HomeMy WebLinkAboutBLD2023-00094 - BLD CD Environmental Health Review - 3/8/2023 �„4,-„.>d r.
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MASON COUNTY COMMUNITY SERVICES Permit No:PERMIT ASSISTANCE CENTER:
BUILDING•PLANNING•PUBLIC HEAL 1'H•FIRE MARSHAL615W.Alder Street,Shelton,WA 98584 ,.,„.'514�q,- Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
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v- Belhair(360)275 4467.Phone Elma:(360)482-5269 ,!
BUILDING PERMIT APPLICATION 6/$ w• 24 'Q7.�
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATI N: Eder c.
NANItre1 �IV�IL C�,r s' )'I-Y1- ' NAME: r�i�t ter-) �I 4 ra
MAILING ADDRESS:,3u1 ,r9✓b,4 i ,(�/ MAILIN�q ADDRESS: IAJ /V)' in q.�L /¢JJL ��
CITY: p1 STATE.;,( ) ZIP: ry) CITY:, ii2. K c./)Cf STATE: 'VC, ZIP:"irt:le�
PHONE#1: f3- 1j0? ^ V 6 Er-1 PHONE;14,b'c*Q,-j&a,1y]
PHONE 42: EMAIL:_
EMAIL: L&I REG# /Y)melt`'� '4 ocEXP. I LI l y czy 73
PRIMARY CONTACT: 0 NER❑ • CONTRACTOR 0� t'OTHER❑ I'Tl
NAME __ LI 1 "/ ( I' Ystii-G EMAIL / / (}�C C co
MAILING A RESS J S 7/1 IQ / to/ CITY r `I a STATE if.)* ZIP ( 0 rn tv
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PHONE - /CELL w
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PARCEL INFORMATION: ENVIRcI V/ft jNTA
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PARCEL NUMBER(12 Digit Number) Av 1-7{ 9/ " ✓ — ck3.3 ZONING H EA>LTH
LEGAL DESCRIPTION(Abbreviated FIRE DISTRICT
SITE ADDRESS _�1/ ( n 1 G C.aim Gc�„7 CITY I ►'Y) '
DIRECTIONS TO SITE ADDRESS L O 7o p in -- pc P irrY/�14_� FRLL/e
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES°. NO❑ SNOW LOAD psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage.Commercial Bldg,Etc.)
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS.
HEATED STRUCTU ? YES(Whole Big)�YES(Parr/sjof Bldg)
P NO`❑
DESCRIBE WORK�.✓J..r 4-1 / i 1 ,, h •C4) p` �,L `7�''
6Q- iM i L,21E .
SQUARE FOOTAGE:(proposed)
1ST FLOOR bliftlidsq.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❑ • CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATI N: *4 COPIES OF THE FLOOR PLAN REQUIRED*
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MAKE C�r ODEL Q � YEARtc �/ LENGTH 7
WIDTH)l BEDROOMS BATHS SERIAL NUMBER "C
ENVIRONMENTAL HEALTH: ,4jidXf LCG5--CC1cob
SEWAGE/SEWER SOURCE: SEPTIC -• SEWER❑ / NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOV-- EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS & TOTAL BEDROOM
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'6F CONTINUATION OF WORK O,,N1 HIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION-OF 180 DAYS-OF MORE-WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
K1 ..--` COUNTY CODE 14.08.42)
S' nature of O ER(Must, a signed by the�NEf� Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL �r n
PUBLIC HEALTH Q1 A),'/Z 5 C V 4 fi14, SS`'10�A
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��, ,�, RECEIVED
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