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HomeMy WebLinkAboutBLD2023-00122 - BLD CD Environmental Health Review - 3/9/2023 : '''''''-'', MASON COUNTY COMMUNITY SERVICES Permit Nor?)1 I[Y (523 —00 1 22. 1/` PERMIT ASSISTANCE CENTER: �� r •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL - •I U F!-- 615 W.Alder Street.Shelton,WA 98584 / '�— `� &D f� Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phoib MAR 0 9 cuL Belfalr:(360)275-4467•Phone Elms:(360)482-5269 J4N BUILDING PERMIT APPL144TIONRECEIVED 3O 2023 S IA, PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: A Myer NAME:( ) s d'dJ ''",,-.1.,,, c:;",z. r NAME: J ;I,. L4., I1V,.,c (c;,1(c St v, (' reet MAILING ADDRESS: r H 57/"3 :L 1 A.rz b MAILING ADDRESS:(I C vt.a 41(r,L CITY: K.,(,NI-, STATE:`L'J ZIP:S/';71 CITY: (jlwlhc:1 STATE: '%,)` ZIP: cI K 54--'-1 PHONE#I: 2 53 - (I;►-i19v; PHONE:3 C C •,./7-((C 7 CELL: PHONE#2: EMAIL: ,:.,A,-h.,. c.- 2x•,I,I+t,•,t, G 0;14 EMAIL:MC,11+mar 19,r ofti+rc.44-.. a-i- L&I REG# ''r4fy7 EXP. b' l_I /L3 PRIMARY CONTACT: I OWNER 0 CONTRACTOR giOTHER❑ NAME'fain'.r•4,, i=r 11e te,"H I r EMAIL ',,I,L.1,.' s.c..' G' ,,,.s1,i-e ' .c i pi �f' MAILING ADDRESS el 12ynr ` Ilr n 1;1:•. CITY SIte STATE i.✓ 53''1' ZIP 5 6 PHONE /::( 12 7-E C L 7 CELL PARCEL INFORMATION: /O PARCEL NUMBER(12 Digit Number) 32- IC 'Sr— )30 ZONING Iy-1 ei;((rr?'�'i, I '1((‘' • LEGAL DESCRIPTION(Abbreviated)(rir•t. 5..4: 2- a t - IC) (i•'- '3 el FIRE DISTRICT 9 <7 SITE ADDRESS $0 N .SisvA li.,te_ CITY d^:ll Ise.c,r (1% DIRECTIONS TO SITE ADDRESS , . f� `y IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO® SNOW LOAD:1{S.psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER 0 LAKE❑ RIVER/CREEK❑ POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM 0 TYPE OF WORK: NEW2' ADDITION 0 ALTERATION 0 REPAIR❑ OTHER I.1 USE OF STRUCTURE(Residence.Garage,Commercial Bldg.Eta) 0.2 4:Ll i nt p IS USE: PRIMARY 0 SEASONAL® NUMBER OF BEDROOMS I NUMBER OF BATHROOMS I HEATED STRUCTURE? YES(Whole Bldg)is YES(Part[s]of Bldg)0 NO❑ DESCRIBE WORK I'i:w /4_0,4ei-v-t,i 1I.,''^( SQUARE FOOTAGE:(proposed) 1ST FLOOR ;'2- sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR C sq.ft. BASEMENT sq.ft. DECK 11; sq.ft. COVERED DECK ;I F/ sq.R 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* J .4 b MAKE IS.4'(•'ih r(>:v/ NG Vf(S MODEL/f iiG l•( '•?ti, 2e72i - YEAR 2C .; LENGTH '/P'`I WIDTH BEDROOMS 1 BATHS 1 SERIAL NUMBER 2.2.Y h I Li 7`fL 1 ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC 1n SEWER❑ / NEW 0 EXISTING Ef PLUMBING IN STRUCTURE? YES Elr NO 0 If yes,attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ 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/apptcation becomes null 8 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 PEER APPLICAT OF 180 1(S OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42) ' Signature NER(Must be stand by the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL /` 1 / PUBLIC HEALTH ..V P 3113I76 23_ NAP AP ii)/ I k l d ett unes. o_ n ov a oH (�.� C o .' Z -Q o � cn �a . � N„m = am pTT �'C7 °N�_ o 'CIznC-N ms-D - m `V" Om v ''q ii mQ = aaa O 2 D Z d � cnn w m ^ mU t ' ° 5 3 d QJcoro v o -D an lo' n N < T. s U` oN 0 s w N d�� �' n n oy ojO t S[ m ]./,`1 nN A1 a Y To k Demos rk FX s/,,� trA l�r av ,� . fade / Cover. anti w;II be 41 caw. Cr 'V \ \ � r j �l 3 i3 s) sr. , p ..... a r " `— Sa-6 ,� s ( i Y r n t WW ^ ____ - ..---... VA(‘ "..) I A_ (..,) c, Ili p l C2 m cn Ili c -a U _ wM Q Q I- LU cr ir, t— :E_I7'1 1 ili ■ X X is ® . 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