HomeMy WebLinkAboutBLD2022-01492 - BLD CD Environmental Health Review __.__..__ . _. - -- • —._- . . ._._ 0.111202/11-6►qg2
-PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Ah,,,P 'r..,I ' t "i_ ;--d, 51-.:;i. f., NAME: a i;f,,a�t 4.,MAILING ADDRESS'.z s2f'D 3 r14rf`'jaK ;r✓ .t,'c✓ S., MAILING ADDRESS: ).!:o/ -' /e,.rl 'S i
CITY: c51,,.,.,�-..� STATE: w�- ZIP:, 1-ss j.CITY: ,a .� ASTATE: ;✓,^ ZIP: Sb k. >
•PHONE#1: 3a a as ( UT 7 ' 735-o'.. PHONE: 1>—.3 67/ 3c so CELL: S._..,,�
PHONE#2: EMAIL : n ; 15 . +^., r•,„ .0 _a--_-.-/
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EMAIL: iL�. ' I' - Co.) !"~ r7 r Tt
^a..l ,e .1 L&I REG# tZR,f�n 495I_ it EXP. 3 / 6 / ,?'i
PRIMARY CONTACT: OWNER ❑ CONTRACTOR❑ THER 4.
NAME >4 , AEMAIL v.- /Oi`� t r,S coc,.� �° 4t'14..- ram.
MAILING ADDRESS A9� A,' &.0 c .-- j I y d CITY Ci j�its ST TE A/ ZIP ` 3
PHONE 3 ' VD 53 45'S' CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 31 g L? 3000 0 ZONING h p_
LEGAL DESCRIPTION(Abbreviated) ;,i; ; ;/ . G„r-1-- J-- a. FIRE DISTRICT 14
SITE ADDRESS CITY }
DIRECTJIONS TO SITE ADDRESS i o i to S= O 1;k (u i yr„..f.,, 1,.I;..1 s.� ,.'I✓.y1-o Qu 0(,-.,,E t s.• ' `v - 1
�'�[ ''" ..-(1, 4 . e,,,1 I- w f2„,n;,t"w ,, > �i IA UN ',1 cn,
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YE NO ❑ HE 'v T/ L
IS PROPERTY WITHIN 200 FT.OF THE FOLLOWING: (Check all thatappl'): ,1 `LT'H
SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION ❑ ALTERATION ❑ REPAIR OTHER ❑
�
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) 5- e 5.14 L r,z ad)1,., ;
- � 4
IS USE: PRIMARY ❑ SEASONAL ❑ NUMBER OF BEDROOMS • NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Part[s]of Bldg) ❑ NO ❑
DESCRIBE WORK •
1,,,
SQUARE FOOTAGE: (propose+existing) Q tb 0 6) $F o"F rnLSV`te
1ST FLOOR sq. ft. 2ND FLOOR sq. ft. 3RD FLOOR sq. ft. BASEMENT sq.ft. 3
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 INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE , MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER .
ENVIRONMENTAL HEALTH
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW ❑ EXISTING
PLUMBING IN STRUCTURE? YES ❑ NO ❑ 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 permitfapplication 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
COUNTY CODE 14.08.42)
x r ,. �� f t?/./.
Signature of OWNER(Must be signed by the OWNER) Date
Adiiimmummimmr
MASON COUNTY Shelton(360)427-9670 ext. 352
DEPARTMENT OF COMMUNITY SERVICES Belfair(360) 275-4467
Mason County Bldg. 8, 615 W. Alder Street
Elma (360)482-5269
PIA r Shelton, WA 98584
• �A www.co.mason.wa.us
REQUEST FOR BUILDING PERMIT EXPEDITION • ( ‘-t
Date: f/31a c 1AG
Permit No.: 1� 122o ZZ -01LiRZ r f
Name: Ark.( f; ( ►'lari;e S I k vLS • f �~
Mailing Address: c,,.yk;}e% e .t/
Parcel Number: f' a3.Q 3 0a& a t) /J/ J/��',711'
r�d S� �t f iLc �'VN4 '1 IcIv ���/- Y'✓ 1
Site Address: � �y q
Request due to: ❑Medical Hardship ❑Fire Damage ,Other
Explanation of Hardship: c' oie •K eci;c1. \, ✓! �" r�A>-•t h :wad
Must include supporting documents.This may be a letter from a doctor, insurance claim report, report of fire damage
from appropriate fire district representative or other relevant documentation.
I (WE) understand the intention of this form to determine and document justification for expedition of a building
permit to alter or reconstruct a structure on theaboye named property.
Signature Owner/Agent: 4//h
OFFICIAL USE ONLY
Request: 'Approved ❑Denied Date: r24 2l'1.0 22--
Request denied for the following reasons:
Signature:
Director of Community Services
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si I i i 6 IRISGROUP
r i APPLEBY/STEPNENS
i n 11 a a i SITE PLAN SLOPE REINFORCEMENT
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g,0 160490.195S 1299 N M6rY.1 M.Cn.n.iin,WA Ste n
BARIEKMAN BLVD
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SALE-1"=40'-0"
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[': I 6:.-7ii,4. 1/26/23
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40,;• ADAM J.HUNTER Vttt
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CARPORT
WELL. ,,_.-----
/'3 BDRM RES W,
•\ 10I EGAL.SEPTIC TANK
•1110 �f
/f
//.,`DRAINFIELD
(LOCATED BY HOWDY'S DOODY ON 1/26/23)
l
_ EDGE OF BLUFF
PUGET SOUND
JIM HUNTER & ASSOC. CONTRACTOR
P.O. BOX 162, OLY, WA 98507 UNKNOWN
753-1226
JHANDASSOCIATES@HOTMAIL.COM INSTALL DATE - 1960s
RECORD DRAWING SITE ADDRESS/LEGAL
150 BARIEKMAN BLVD SE
OWNER- FINAL DATE
ANGELA RUSH(BARIEKMAN GUEST HOUSE) 1/26/23
TP# 31923-23-00020 SITE #