HomeMy WebLinkAboutBLD2021-00376 - BLD CD Environmental Health Review - 1/22/2021 „. Oti 06U.yc,; MASON COUNTY COMMUNITY SERVICES ��d26�I D
PERMIT ASSISTANCE CENTER: Permit No: 0114�
I1111ki. -
, ”. •BUILDING •PLANNING•PUBLIC HEALTH•FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584 6-I A RECEIVED
��.�ok. • Phone She (360)427-9670 ext. 352•Fax:(360)427-7798 Phone y
' l ?60)275-4467•Phone Elma:(360)482-5269 \�v
. 54 N JAN 2 2 2021
� �I � � BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER IIN1FORMATION: CONTRACTOR INFORMATIION:
NAME:_ 1,PJUL A �J 15 NAME: Aiie_t4, —�o wtes& C6ns�rv��,o�
MAILING ADDRESS: ' 13 5e rn &Gt i MAILING ADDRESS: PO Q,x ZJK.3
CITY: tQ {/YL, STATE:(Alyi BSPY-t CITY: ?e,1-{-oc� STATE:_ZIP: S51`1
PHONE#1 ���111 _ PHONE: D ` Z7-7z81 CELL: 36o-�7d�`�6La
PHONE 42: r ,,ap,Q J EMAIL : l le es cl' t1 .Go
EMAIL: J,�•-r'i A I L.P'l Lc) (.;J f_ u# &I REG# L A/ H C 8 21 EXP. 63 /3 i ,22.
5
PRIMARY CONTACT: OWNER❑ CONTRACTOR E OTHER❑
NAME To1.t1 Alibi\ �j EMAIL
MAILING ADDRESS PO 3ok 2103 CITY Ike( v\ STATE V4 ZIP SS1"f
0 PHONE 360-701-56lC CELL 360- L27-1L51
PARCEL INFORMATION: ff,, R
PARCEL NUMBER(12 Digit Number) 3202`T 51 . 000 13 ZONING S
LEGAL DESCRIPTION(Abbreviated) S10410 KUM F tr*1jjead-Sir'' 134•"t C.•FIRE DISTRICT
SITE ADDRESS 373 5E. Morzan Rd CITY Shie141:41
DIRECTIONS TO SITE ADDRESS L.QS{- 4 Arcadia, to` ow paS4" -I-Le be NI , l,00 1< 1?or e- b;3 woo dein So" ir,„
can - le-r-i- 4-11J readc W $5 13ACO/1/ c 7.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO ❑
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWA I"ER❑ LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑
TYPE OF WORK: NEW [ ADDITION lYil ALTERATION ❑ REPAIR 7_(, OTHER ❑
USE OF STRUCTURE(Residence, Garage,Commercial Bldg,Etc)
IS USE: PRIMARY SEASONAL ❑ NUMBER OF BEDROOMS NUMBER OFBATHROOMS
HEATED STRUCTU t E? YES (Whale Bld; ❑ YES (Part[sl of BId J NO{] A n V
DESCRIBE WORK •,1 A r_. ,�--`` --..'
Al PINE111111.'SQUA 00 ,, i : (propose+4 sting)
1ST FLOOR sq. ft. 2ND FLOOR sq. ft. 3RD FLOOR sq. ft. BASEMENT o 3 sq.ft.
DECK C(bp sq. ft. COVERED DECK sq.ft. STORAGE 144 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
TH BEDROOMS BATHS SERIA BER—_
ENVIRONMENTAL HEALTH: , .
SEWAGE/SEWER SOURCE: SEPTIC 1 SEWER❑ / NEW .. EXISTING)31
PLUMBING IN STRUCTURE? YES' NO ❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NO❑ EXISTING SQ.FT.
EXISTING BEDROOMS 2• PROPOSED BEDROOMS D TOTAL BEDROOMS oL
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 it 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) Subrn v1 /t'l !"oZ%,-
x qi1,7. m-ob4 ,c-44/21--) 11/q /20 ...,1-3,..1-1
igna ure 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 ! wLb `�`� L
. BL.� .Z.o�. ( _ C ))7 so
2169456 MASON CO WA
Return to: 16/25/2021 12:26 P11 CERT
FF _ C...), 2 l‘ riEfe iri leillllnl Iilllilf P�l�fii llflll
c, Lv�
�m 1411e17'
CERTIFICATE OF RESIDENTIAL USE: LIMITATION ON NUMBER OF BEDROOMS
__I(Wel the undersigned,hereby place.this notice on record that the following described real estate situated in
Mason County,State of Washington;to wit(Division and Lot Number or Range/Township/Section Number.
Note:Range,township,section numbers arc the 1e 5 digits of the parcel number)
SICSAWrFArltrng5 it131-`r L, OR
Subdivision Division Lot nn Range Township Section
and having the Tax Parcel Number of:_a, V --5.q -- d 0 a
is subject to the following understandings and conditions:
1. The use of this parcel will be restricted to no more than 2— bedrooms.
2. The on-site sewage system was designed for and the building permit was issued on the basis of no more than
_bedrooms,and a maximum residential occupancy of no more than 4 persons.
3. Use of the other rooms as bedrooms,in excess of the number identified herein,could result in hydraulic
overload and premature failure of the on-site sewage system,and could result in Mason County taking steps
to cause vacation of the premise.
4. In the event of any future residential remodeling,expansion,or replacement that results in additional
bedrooms to the number specified herein,the property owner will obtain the appropriate permits for
expansion of the on-site sewage system.
Dated µ` this day of 20 a k- _
- Signature Signature State of Washington ) Grantor:_rai `P_6 /y/��e- l 5.
County of Mason ) Grantee: Pr.' bl i C
1,the 1u dcrsigned,a Notary Public in and for the above named County and State,do hereby certify that on this
_.5sy of_ _ O 0i. c ,20 \ , Tze_r-e S w %, GA.S S personally appeared before me,
who is known to bc,signer of the above instrument,and acknowledged that he(she)(they)signed it.
GWVEN under my hand and official seal the day and year last above ' n.
\\\\\\ 111,, +i rr�////��/ Notary Public in an for the State of Washington,
,<Q.\N,...M•Q,9/�i residing at (S�'1�JfOn. (J A
` vi Fe'�0 20 4. '.t5' - My commission expires:�`—I d---b ..3
�•'o o1O ' ? m..,
' ' NOTAfiy 4 .
em.•.+ =
N o' pUBt tC oe..O
c< ••!yumb0 •',NO '
�'1i of•
WASN� �`�� L O C T 2 5 2021
tit11/rtIIIItttt 0
By 4 ).--
r
yg i 2 dO Z 2
.;m). r G
ik
A ' 2. C) ZA rn
PARCEL/320242222222 ` a x.z'+ i
,o z.A '
`•
'11 µ VI ri <cxz ,,..
2 o
\13P.'\\1‘14‘E-CS\-----
N A
; NAma
rn ;MI O
1nMI oz n •
,
n
Kt
�=]1 t
P
R i
70 ... '',,,1
�o NMco
I#J.
N $
\\\N
q
11
•
1 P 1 i 11 ' ::*,
.,sir
--.:-...400 -41,
g% ..:•::.•.-J1. :'•'.e Ait 0, • §
,,,. 'ir.:: /ii/R., \ H
A :� K N Z r OEll Z'4/
I
—331•, o
I".1, 4 if 4,,,, ! * n't
C 2p_ / A
til
Ill ,_., :;... .,
•
70
� �F YV I \- rn z
2 g a 10 V • J 8 L o (/) _
i .A1 -•
._ 'mil I ° - D Z
m {.s"• /_
r*t :?r.t a O S� z
Z_�-o Z
o I // a 0 n m
/ �� § U
� p / v :' t rp Z. M o
11
i ii:;::::,!
g to ,z.v. § w.111 ,Iv- ..a.S Gil. Z
I g
0 0_,..-0
!,, * m —I
'S•' •f / ul •'
Dz
Y/' Lil -
aiS
Y P <Y
o
7•.'r s 'ir., g
e;VA. I ::i.''4.': 2 ;21-
A'F O N
,.
o %tn !:r. O
'Fn Z
p'Y.:,;.v t fir''' -r:i,,,'1.,.. n y
.4 se?:•f ~`i ce• y, Uj 'k7'i�.
Car
.'s.:�{s. .a:?Y ptpi. 'Mt.
3u;. ..;Id.; K Q T b
#, r T v
f f '. :ifs"•;1. I. •r• m T ,
$ 4. `,:. ;'y .i ::::: �f: 1 Z 9a{. R.O.
N �r:kt'''+t y;•!'VX,.�tt,:,0 4 I 3 0 EXISTING EDGE OF PAVEMENT
r 7+r;�V`.,•c q n': Y h)..• y ip,• —• — y w — — — -MORGAN EXISTING EDGE OF PAVEMENT -_..
— — —
SCALE EQUAL TO 24'x36•- CONVERT SCALE FOR 11'x17•
g 1 I i F ' Sheet Contents NO. DATE REVISION
1 SITE PLAN 9 10-21-19 REVISE DECK NORTHWEST LINE
d 10 11-04-19 REVISE DECK
N O < Project 11 0J-25-20 ENGINEERING REVISION
9. ALLEN HOMES CONSTRUCTION 12 12-152-2 PERMITTING REVISION WO RX
G O a n 13 01-1 -21 PERMITTING REVISION 2
tip TERI WISS L.L-C-
373 MORGAN RD. 360-951-7699 •www.northwestlineworx.corn
SHELTON,WA 98584