HomeMy WebLinkAboutBLD2021-00403 - BLD CD Environmental Health Review - 3/23/2021 OS�y.,G•Pi-'1. 1, MASON COUNTY COMMUNITY SERVICES Permit No: alai <o3
PERMIT ASSISTANCE CENTER:
• �` •
.C� •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
FI t" '3 615 W.Alder Street,Shelton,WA 98584
y••f Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone r 11
� r N4tir BeHair.(360)275 4467.Phone Elms:(360)482-5269 7j 1 ly,E- f t
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: : L`. et!?f
NAME: )reft:f 614 1 e r` NAME:Bea CoiY)�l oDil" A i/'I e,
MAILING ADDRESS: / 5- i '4'' ' • MAILING ADDRESS: PO F3v( 14,`f - "r �'1l-(:
CITY:I�Nit-65; P1)k�C' STATE:U% ZIP:cie464 CITY: e f/it STATE: Wff ZIP:' a 51
PHONE#1: 253-273-g$$$ PHONE:.? .3-?577-Iasi CELL:.Q 53-677-2&%4
PHONE#2: EMAIL: Lot,sh'it ►0)-,//c cliff_h Do,a)iv)
EMAIL: bl^e.t ITS 0SIrt.a.il.CD"rt L&I REG# 13EARDCL055 BS E . ,3 le 1.3
PRIMARY CONTACT: OWNER❑ CONTRACTORg OTHER IE
NM AE s. re,--vs-f-ksuc,(2)6,, Le_c_ EMAIL beu-Vli(LOytS ucf-IOYrnCC''i{AGtOCI.L9t4't-
MAILINGADDRESS 0133C')( 54,q CITY (9/A((a- STATE 1,0i4 ZIP ,Jq.P3SI
PHONE 3--4.-7 7- la5I CELL 053- 77--Z - 6
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 32274-5O-6 2"10�" ZONING /1 R 6
LEGAL DESCRIPTION(Abbreviated) 4-great Belt1 L&J gliatcfs BIk: 2 TIL/{- V t/z• IL. 43 27
SITE ADDRESS /(v 3// Ale Nor Lt Shore kfj CITY ialiuir-t. r
DIRECTIONS TO SITE ADDRESS `J ... VMEN
VJ C A ,T
-• IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%.: YESS NO❑ SNOW LOAD:_psf °`/,IH /V
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)g, ADDITION❑ ALTERATION{� ❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) /{eS 1 vic-
IS USE: PRIMARY❑ SEASONAL jg( NUMBER OF BEDROOMS I NUMBER OF BATHROOMS a,
HEATED STRUCTURE? YES(Whole Bldg)g YES(Part's]of Bldg)❑ NO❑
DESCRIBE WORK
SQUARE FOOTAGE:(proposed)1ST FLOOR f alf0 sq.ft. 2ND FLOOR 573
sq.ft. 3RD FLOOR sq.ft. BASEMENT J / sq.ft.
DECK 3 2- sq.ft. COVERED DECK /20 sq.ft. STORAGE sq.ft. OTHER sq.ft
GARAGE 5 1-5 sq.ft. Attached, Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
?q
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: S wy 2o2e9 -605o L.
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW , EXISTING❑
PLUMBING IN STRUCTURE? YES g NO❑ If yes,attach completed Water Adequacy For—
PERIMETER/FOUNDATION DRAINS PROPOSED? YES g NOD EXISTING SQ.FT._ •
EXISTING BEDROOMS_ • I PROPOSED BEDROOMS TOTAL BEDROOMS I
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)
X �� �� Z3 -'L�2 1
mature of OWNER`(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH (Z) q 41 z 3 CONA��111NS 4-604
L i. Ill
1 .if§Wr f Y 5
1ll
• 6 1 ii
> I I „% g' WI.I I r I 1s 585111111a11$ 11E 6 Z <
•
4 L ! i a q Sq y$ , S t P C p r WI:iii Y �!r4L ' I I i illi ? 3
0 114 , t I
3 i i % # i 6 f p $ _ F $ $ R R ag to O
g€ 5
• �' j A A I s gyp �y
WI il /2!
37 s—m._
m sg.'m ;i a i4�
"Hm2mm
a
n .0 omd m�at
g al 3cm m A
pO - m O Knitl .�
a ' T.. < 2 a.0 s
ru
A T � S as,.
Z.
NO Cl m S ..g O
w m ru E gm a>; I /.�
'z°� moo'"a w
tN �a d_Zi n u
a 7�
o ao3 N,
1 N a�`
y �, Z m
o�� m
X . € :1¢al ill . NN x -I m 0
gas x
a nrn N
i a A rn o
r 0 0Q00
• •. IlW.4. orm.,on l / • l r I N ir— N I I
•
t $ 0; _ 3 t� e �4A�ti I i i -1'--•:'sardoo i i .-
An nlni l 3 i o
a k .. " '.Pow I. N w
;41Y ))
`val• a '4 :" 5 C •I 3
•
o�y rn
. a
CI
} gg
s
a
Euo°o ! 9 ar ■g 4 itg tR ill
£ mE s g;3 ; g; A$ s"aiiIt ; Ai§ bti 3 ° R aR'
� ,1R3iF Ig p "i ' iI
x t9EEcd $ 115 {b89g02R g . Ib IIIII
ii 1 g hh T 11Rih; pabp k> k€€ $ 9QRQ -9i
illa = ai4>7 � Sf j n� b ya
9R 9; a 4 it 2R iil 4 Rii $
Ail g £ i i! ' Ra4 I aR 4/ d
an
'£N 3 k COVER SHEET/SITE PL4N ..o. asaa.no.. MU pre
a ,i 16311 NE NORTH SHORE RD BEYLER o+�,r
' rrC}► SITE DEVELOPMENT °^""'"' ++,.+.«...+ ,+
0 W • r�•. MASON COUNTY
WASHINGTON Plan.Design.Manage ��s� :=��
��01 masmo ouw. swam. aw+. 0*1
,.+, T(Al .00 -00110i $.1. v+an N/A 1J/31/2027 «a...o••.er .o..