HomeMy WebLinkAboutBLD2023-00218 - BLD CD Environmental Health Review - 2/28/2023 ,,,\>>\''l'''A 4, c.
.s.. . MASON COUNTY COMMUNITY SERVICES Permit No. l! 0 AI' _-',RAS
PERMIT ASSISTANCE CENTER:
�'t` •BUILDING ASSISTANCE
HEALTH•FIRE MARSHAL �.r'
.1 1• 0 615 W.Alder Street,Shelton,WA 98584 l5►� ' FEB 2 8 2023
z FEB 2 7 2023 RECEIVED
f $' Phone Shelton:(360)427-9670 ext.352• Fax:(360)427-7798 Phone
?it -1y�' Belfair:(360)275-4467• Phone Elma:(360)482-5269
'°�.,u,,�t•�•'1 ��55 lder StreetEN
BUILDING PERMIT APPLIC�TI6I� FIVIRONM
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATIO\E�L
NAME: !4 jt'_ 1, NO VOJC NAME:
MAILING ADDRESS: 0.0 t%1 r i_.: g.,‘ MAILING ADDRESS:
CITY:N0,\. . f- STATE: W P, ZIP: 9 8 S9-41 CITY: STATE: ZIP:
PHONE#1:3b0 tg o $14(4-5 PHONE: I CELL:
PHONE#2: 34 /v 2_3 — a )--bq EMAIL :
EMAIL: f\O vb.-V. 145---a pf, , .o (v, ' L&I REG# EXP. /_/__
0 PRIMARY CONTACT: OWNER i4 CONTRACTOR 0 OTHER 0 Q �m
NAME �{• i� Nov ��
EMAIL C� i� I OLASL�14S .& J
MAILING ADDRESS 17.0 N, L e--5vn L-a-1/4 Q$ CITY STATE LA I r ZIP $5
PHONE 3c o (, 2.3 7 $a CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 1 9-. '3 1 — 5 O — &op( I ZONING
LEGAL DESCRIPTION(Abbreviated) ` FIRE DISTRICT
SITE ADDRESS J 2-0 i.t j f_�t r6 Dt'\ L tom\ RA CITY Be.-)•S-ad r/
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO ® SNOW LOAD: ]„Spsf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER ❑ LAKE 0 RIVER/CREEK❑ POND ❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW ® ADDITION ❑ ALTERATION 0 REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Garage.Commercial Bldg,Etc.) Gq,'('e..5e—
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Part[s]of Bldg)❑ NO al
DESCRIBE WORK
SQUARE FOOTAGE: (proposed)
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq. ft. BASEMENT sq.ft.
DECK sq. ft. COVERED DECK sq.ft. STORAGE sq. ft. OTHER sq.ft.
GARAGE 6(01 sq. ft. Attached❑ Detached❑ 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 SEWER❑ / NEW ❑ EXISTING
PLUMBING IN STRUCTURE? YES NO,- If yes, attach completedWater Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ 0 NOSf 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/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
COUNTY CODE 14.08.42)
b N\ ‘\\\\C4 9,
ignature of OWNER (Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHA9F1
( ��,,
PUBLIC HEALTH 71 L� CU' S
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EH APPROVED _ __--- ---
Rhonda Thompson 04/03/2023 3- .- or • g:Li.
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EH Setback$
A.) Drainlield/Reserve requires 10 setback fro4footing/foundations
B.)Septic tank(s)requires 5'setback from all footirig/Joundations .-- • .
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C.)No foundation/Perimeter Drains within 301t,downgredient of •
Drainfield/Reserve area , .. _
D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)Within
50ft,down gradient of Drainfield/Reserve area --• Ii
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