HomeMy WebLinkAboutBLD2023-00237 - BLD CD Environmental Health Review - 3/3/2023 • a4�ti•v•sue`rr•%fK1)' MASON COUNTY COMMUNITY SERVICES Permit No: (/�2 02✓ °02 3 -7
PERMIT ASSISTANCE CENTER:r7 • JJ
�` •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL 1 [f
�_ r-',;� 615 W.Alder Street,Shelton,WA 98584 i ,
�'.1 7: ,�(b fry Phone Shelton.'(360)427-9670 ext 352•Fax:(360)427-7798 Phone V 0
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r, by 8e/fair.(360)275-0467.Phone Efma:(360)482-5269 MAR
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BUILDING PERMIT APPLICATION 67 S vt/ 1 2923
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: 4 k i e r
NAME:( i - II ,l, ..lr.;,, .S, Qcrn , 4-z` NAME: E'( 2M
MAILING ADDRESS: _Xt)e) i'- Lc1 J tie !' s r 13It1 MAILING ADDRESS: t—�Lf11
CITY:'5 I1 e 11-e,�1 STATE:LU.¢ ZIP:'ZIP:q115ci,i1 CITY: STATE: ZIP:
PHONE#1:V..0 qc5--59-1 1 PHONE: CELL: MAR 0 3 2023
PHONE#2: Zlq- t-ic6- lCe1.- EMAIL: A..
EMAIL: Eq:rei.w.►wngrai3'C7 �/r.hco.CO:+1 L&I REG# �k /— RECEIVED
PRIMARY CONTACT: I_ OWNER Ix CONTRACTOR 0 OTHER❑ ` 0/`,�
NAME _Sa,4i 6$ crFJO(/- EMAIL Y
MAILING ADDRESS CITY STATE ZI (,•.�L�. Fib.,?
PHONE CELL ` /`/ l
PARCEL INFORMATION: /
PARCEL NUMBER(12 Digit Number) )..,2OO Li :2, 2 Y O if 0 ZONING _
LEGAL DESCRIPTION(Abbreviated) FIRE_DISTRICT
SITE ADDRESS 1 . i I ct e Ll i i CITY ,5 1-e f
DIRECTIONS TO SITE ADDRESS t i LkQ?t 4- t in i Ifs 5 L•1I<.e ()/) t/I 11C tc,kt
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO ig SNOW LOAD_2S psf
IS PROPERTY WITIIIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW tif ADDITION 0 ALTERATION❑ REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) r'2 5:el e✓I L.4'
IS USE: PRIMARY X SEASONAL❑ NUMBER OF BEDROOMS 2. NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg) YES(Parr/sJofBldg)❑ NO❑
DESCRIBE WORK /U(?w in .tit/ t- t.), fc,ol, '. —
SQUARE FOOTAGE: (proposed) �.,(
1ST FLOOR...Zang.ft. 2ND FLOOR 0 S%`_sq.ft. 3RD FLOOR 95 sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached 0 CARPORT sq.ft. Attached 0 Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
e
MAKE Flee m..4. MODEL 3.?C,1 r1 C YEAR oc OoZ3 LENGTH VI
WIDTH 3Le'9" BEDROOMS ,1 BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC' SEWER❑ / NEW❑ EXISTING lir
PLUMBING IN STRUCTURE? YES isi NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 2 TOTAL BEDROOMS 9
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
P IT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
/� COUNTY CODE 14.08.42)
f 4 C ----- f, 7/vr e/- 2 Q? 3
X
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE. DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL ! �, � ��Q r
PUBLIC HEALTH ?;c7r 5)73n,A CIImo'IIt`t'S oc1 SR
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