HomeMy WebLinkAboutBLD2023-00217 - BLD CD Environmental Health Review - 2/27/2023 Q..r""" r`''nSSt^ MASON COUNTY COMMUNITY SERVICES Permit No:(AA/LolJ—UbZ I 1
P ERMIT ASSISTANCE CENTER:
!!!I t •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
("PT
1- -. 615 W.Alder Street,Shelton,WA 98584 A);"-
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f IPhone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone ���
t� v Beltaic(360)275-4467•Phone Elma:(360)482-5269 \
BUILDING PERMIT APPLICATION FEE?
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: — 61 �, ZQ23
GF- i/46-5 NAME: okSH /i..k-C 1� tiC--,c� S �� ' 'der
NAME:
�i,�<<L-II�I� -��� /r �' tfc Sfr
MAILINN DDRESS: /c Cy,& ( MAILIN. ADDRESS: 7,0, (�YY. ee t
CITY: /ACC IA STATE: ZIP: CITY:6reAZ c/_j-i/`STATE:IiJ4 ZIP:r S
PHONE#1: .X&--( Y{'-— _j,;Z-7 PHONE: 'W.)-7�ti•-CELL:60.'5I
PHONE# : `� EMAIL: h/A-90e--niCirl i a.("12,--4Ci6-1-N"-,l Cb i
EMAIL: 1 LC 1-I/l+GS ...)a -(C 4S(t(L1r<'T IA! REG# EXP. / /
PRIMARY CONTACT: l OW R CONTRACTOR 0 OTHER 0
NAME .. .\(1•1 c AsA-1 ^.:� n.L_-`> EMAIL ".i �6A !'J 5�CC.t-c-A3(ttL7"
MAILING AD RESS I (-'k ( C�. CITY l r-C'f - STATE \- /1 IP 1-4jA
PHONE 2C -{{if-- ,5� CELL .S4.--(t 4'q tt
PARCEL INFORMATION: S r ' . /�YO
PARCEL NUMBER(12 Digit Number) I �`( —��'' -C��17 ZONING `i 4 i
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT b Fit
>SITE ADDRESS ,237 1.--C(eL�(t'�E I4)I- CITY St> - J-= C1 y - Y74/
•DIRECTIONS TO SITE ADDRESS 4.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO, SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATERg LAKE 0 RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW❑ ADDITION1 ALTERATION�0 REPAIR❑ OTHER n
A t USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) > t CC vV C <l ST(t !6Ft-s- l`-
IS USE: PRIMARY 0 SEASONAL, NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 3
HEATED STRUCTURE? YES(Whhool
e Bldg)❑ YES(Part[sj of Bldg)❑ NO,tsr
DESCRIBE WORK A t K i 6 vt t=)CIS-TINE cF
SQUARE FOOTAGE:(proposed)
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.R. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK)) sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached 0 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❑ NOS('
If yes.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOO EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER acknowledges that submission of Inaccurate information may result in a stop work order or perk 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 8 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 APPLICATIO OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
Z7 COUNTY CODE 14.08.42)
Signature of OWNER(Must be signed by the OWNER) to
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL O 7 r�
PUBLIC HEALTH ,4p (1/7141; '(ncli ty1S Cc/C (l/
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