HomeMy WebLinkAboutBLD2023-00247 - BLD CD Environmental Health Review - 3/3/2023 ;ouv MASON COUNTY COMMUNITY SERVICES Permit No= .i. 2dZ3 -O6�L�7
'�A� PERMIT ASSISTANCE CENTER: ,
r f 1 .BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL C
�� 615 W.Alder Street,Shelton,WA 98584 , E C E I V E n
„Iv Phone Shelton:(360)427 9670 ext.352•Fax:(360)427 7798 Ph e �tir Q 3 Z0��
Belfair. (360)275-4467•Phone Elma:(360)482-5269 ECE1VED M A R O 2n2�
BUILDING PERMIT APP 615 W. Alder �lrc�t
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:14Xr"UdU12-A ' PDNfLfl i 4) 4 NAME: _. .—
MAILING ADDRESS/ j, i B )P) A1 A MAILING ADDRESS:
STATE: _ L1Y:,
��L
CITY: •15k--/-'s9 M. STATE:j_ZIP:9A5?a" CITY:" , CELL:r
PHONE#l:,3G,b did) ,� PHONE:,
PHONE#2: V(.O fib) 10 338 EMAIL.-i
L&I REG# y EXP. /�
EMAIL: �IefP�da1�4t12o- Iitl•COru
OWNER ig CONTRACTOR❑ OTHER 1
PRIMARY CONTACT: EMAIL �II1L°T�tuca �0��M4� 1' (�D W
NAME 1A,DRESSA 4 �Yl9/ti CITY (AEU= /k STATE _ ZIP 9��1,2 X
MAILING ADDRESS/aZ)d )id/36�`� P b ��� CA `'
PHONEa�/4O COI 68'1040 CELL J4,b IB) [va4,� tV Y RONI4� !
PARCEL INFORMATION: H�ACT / IA
ZONING
PARCEL NUMBER(12 Digit Number)at�o� b4 -S7—bOao2��� ��� FIRE DISTRICT N
LEGAL DESCRIPTION(AbbreviatcdhSEL.2 liNAL llip2AI /
SITE ADDRESS] n Ali left ap-/? 1PL it( t CITY -Li'-A>A_
DIRECTIONS TO SITE ADDRESS y}rML-3 reprn bEi-M 1g N.S b g 7, Y41ti ilie/1 rL -4F.R?'( f'�,q`�yA 1)
A$w�t)y U p 7144 4)GI-)r ytr ra K_031;V--bigArr3 SI / o/ � O"a�o
pi
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK ❑ POND❑ WETLAND ❑ SEASONAL RUNOFF❑ STREAM ❑
TYPE OF WORK: NEW DC ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) .,a)/bp
IS USE: PRIMARY ❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Part[sj of Bldg)❑ NO
DESCRIBE WORK .30 X 4 D pte-fAI-L i
SQUARE FOOTAGE: (propose+existing) •
q•ft. 3RD FLOOR sq.ft. BASEMENT sq. ft.
1ST FLOOR, ) sq.ft. 2ND FLOOR s
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER/, zbp sq.ft.
GARAGE sq.ft. Attached❑ Detached❑
CARPORT sq. ft. Attached❑ Detached K1
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MODEL YEAR LENGTH
MAKE —
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC d SEWER❑ / NEW ❑
EXISTING DV
NO � Ifyes, attach completed Water Adequacy Form
PLUMBING IN STRUCTURE? YES ❑ EXISTING SQ.FT.
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ O®
PROPOSED BEDROOMS TOTAL BEDROOMS
EXISTING BEDROOMS � _ _ -. :.._.
1 -------- ----
OWNERsignature I misslon of inaccurate information
result In a stop renmdtoo Acknowledgement
Is by
b w.I declare that am the owner and Ifurther ddeclare that I entitled to receive this peil and do the work s 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, for review
the!and the informationh provided Is llcation becoccurate and mes null void If work or authoriz d construrants employees of Mason County access to ct nails not commenced withiove described n and structure(s)for review and Inspection.This prmit/app
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 COUNTYMORE
WI LL ODE US EE 42 E APPLICATION TO BE EXPIRED.(MASON
x
Sig ature of O NER(Must be sinned by the OWNER 4DE PAIuMg`TaR EVI:Rrn-^_� APPRQ EI)i,;-i- ATE � �_p ,IED,•',.:-: ATE --
TA-'6. OTE_/CO�_.ITTNS°
BUILDING DEPARTMENT _ '
PLANNING DEPARTMENT •
_ -
FIRE MARSHAL n
PUBLIC HEALTH
• _, • RECEIVED
'P{a-fl �a•�o' a� .47 MAR 0 3 2023
t ' P c7,r...:,,4 615W.
Alder Street
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( ) CIV AITE '. I,F.e.., S U --
NN ESIlTE . ,�_._.._\ ES 051101 Q
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�� % EH Setbacks t s
A.) Drainfield/Reserve requires 10'setback from footing/foundations I k,
B.)Septic tank(s)requires 5'setback from all footing/fourdations t f O
I /tih, c C.)No foundation/Perimeter Drains within 30ft,downgradient of i,
Drain0eld/Reserve area
1\\ D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within i , ,Q/
50ft.down gradient of Drainfieid/Reserve area 1
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' EH APPROVED ____
_____ r
�r�y..... ................... ..a Rhonda Thompson 04/03/2023 t�p P r
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