HomeMy WebLinkAboutBLD2022-01461 - BLD CD Environmental Health Review - 11/15/2022 liter
."�� �I. MASON COUNTY COMMUNITY SERVICES Permit No: ?Aka'
j •1 / '� PERMIT ASSISTANCE CENTER:
1 •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL r
_- 615 W.Alder Street,Shelton,WA 96584 ��[[[ t .f v
aY Phone Shelton:(360)427-9670 ext.352••Fax:(360)427-7798 Phone �rtil ,t j
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j. Dellair:(360)275 4467•Phone Elma:(360)482-5269
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BUILDING PERMIT APPLICATION •
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: 675 V�V, fit; .r
} NAME:Hat John NAME:travis Rowland (1-031.
MAILING ADDRESS:24230 SE 42ND PLACE MAILING ADDRESS:1091 se craig rd
CITY:Issaquah STATE:wa ZIP:98029 CITY:shelton STATE:wa ZIP:98584
PHONE#1:425 466-2387 PHONE: CELL: 360-870-1287
PHONE#2: EMAIL:travis@foxheadconstruction.com
EMAIL:johnohall58@gmail.com L&I REG#foxhehc943ke EXP.04/80/22
PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER 0
NAME".+8rC""/ EMAIL travis@foxheadconstruction.com
MAILING ADDRESS 1091 se craig rd CITY '''.4,.:" STATE we ZIP98584
PHONE CELL 360-87°-1267
PARCEL INFORMATION: EA;v�R/�
PARCEL NUMBER(12 Digit Number) 220161200060 ZONING " '�./N A
LEGAL DESCRIPTION(Abbreviated) PCL 1 BLA#01-50 PTN G.L.1&TX 1212.0 S 27/19 FIRE DISTRICT •� ►!�n/7"A
SITE ADDRESS203 a schneider rd CITY shelton /.T.& r Y 11 C
DIRECTIONS TO SITE ADDRESS non hwy 3 rt on pickering rd,rt on pickering,left on schneider property on left //
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO 0 SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK❑ POND❑ WETLAND 0 SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION❑ REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence.Garage,Commercial Bldg,Etc.)shop
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Perils)of Bldg)0 NO
DESCRIBE WORKnew stand alone shop
SQUARE FOOTAGE: (proposed)
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK 150 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE510 sq.ft. Attached❑ Detached 0 CARPORT sq.ft. Attached❑ Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC CI S • : / NEW 0 EXISTING El
PLUMBING IN STRUCTURE? YES❑ NO El If yes,attach completed Water Adequacy Form
PERIMETER/FOUTIDATION DRAINS PROPOSE II. YES 1: .NOIL, EXISTING SQ.FT.
EXISTING BEDROOMS CC PROPOSED BEDRO S ne TOTAL BEDROOMS na
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
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
E 14.08.42)
X 11/7/22
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FTRE MARSHAL ( (�
PUBLIC HEALTH _Ye _ .phi`{15 r�� .�l S
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