HomeMy WebLinkAboutBLD2022-01034 - BLD CD Environmental Health Review - 8/8/2022 oSao"'G.nr^tttk^ MASON COUNTY COMMUNITY SERVICES Permit No: !/1 I �.Z - 010�`f"
�s PERMIT ASSISTANCE CENTER:
iA 72 BUILDING.PLANNING•PUBLIC HEALTH•FIRE MARSHAL R E C E J V E D
��4 I- C 615 W.Alder Street,Shelton,WA 98584
7
11
'yam Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone I
9;YG ‘• Bellair:(360)275-4467•Phone Elma:(360)482-5269 AUG { n 1
BUILDING PERMIT APPLICATION 1�l IL 3
PROPERTY OWNER INFORMATION: CONTRACTOR INFO]2MA I�' 'An: E r Street
NAME: at 05 'PtuS-e. k\A NAME: V1516 Flo'S4 ve , 1'nL..
MAILING ADDRESS:;24 Ir tr:. �r: Q3v1 AILING ADDRESS. Po OrOX z,19 2.
CITY:She%it". STATE:W\► _IP: CITY:S1nG1 4ort STATE:lnl II ZIP: y K SIN •J
PHONE#1: 360• .(9V• 9 3 tO PHONE:4/2,•94(x•j CELL: N9p•1;•
Icp X�.�.
PHONE#2: EMAIL:Ah �, uM+ . (71C•l. .c•J 1
EMAIL: C ln43%w Q ej itgt1N_ . COM, L&I REG#4 'EXP.5'/ J/25 Z
PRIMARY CONTACT: OWNER V" CONTRACTOR.' OTHER 0 LU =
NAME r .S TANA`.L}"INEMAIL f L—
PHONE
MAILING SG.rA. L. O e-, STATE ZIP
CD Lli
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) Z2 011• 15 • 000'1 I> ZONING
LEGAL DESCRIPTION(Abbreviated)rt 4 i Cri ti"tc 3 L 3'21 a2.4-�4 FIRE DISTRICT
SITE ADDRESS.;/..." E t).f1 vs t t!vE>; 1.i, CITY Si tri.lb Z
DIRECTIONS TO SITE ADDRESS'it '1.3 Z Ul-i IS.6!Sl t i2 t t'T b7 , c-16-pc. �i 1:0- 1 W '-'
bo l 'S{xtNi.S It,J 'IS, CIr.: LC Pi 3'L-r, 1t—]:u naFt IZ-ifat,tr
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO I. SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW a ADDITION❑ ALTERATION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) J t"Iz.
IS USE: PRIMARY EL SEASONAL 0 NUMBER OF BEDROOMS NUMBER OF BATHROOMS 3..5.
HEATED STRUCTURE? YES(whole Bldg)0 YES(Parris]of Bldg)a NO 0
DESCRIBE WORK Ct.V S T Z- ' A rpsrw A Li CL.€ 13` j i I?
SQUARE FOOTAGE:(proposed)
1ST FLOOR 2 11-1`j sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT t i'A A- sq.ft.
DECK LI L sq.ft. COVERED DECK 2 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE i�:'y sq.ft. Attached IS, 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 g EXISTING 0
PLUMBING IN STRUCTURE? YES®- NO❑ Il'yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES($ NOD EXISTING SQ.FT.
EXISTING BEDROOMS 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 (IJ LL_
j Signature of OWN ust be signed by the OWNER) �� /-` Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL t
PUBLIC HEALTH Ali 1-1 5 l L `J a..4Id\
•
Da,\ S?r;rv3s R�
s32'
EH Setbacks `►�(I
A.) Drainfietd'Reserve requires 10'setback from footing/foL ndations
� Septic tank(s)requires 5'setback from all footinglfoundatlons
)No foundation/Perimeter Drains within 30ft,downgradie it of
Drainfield/Reserve area C.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within M el O dl (,��SC
5Jft,down gradient of Draintield/Reserve area N WY1t C1 h<�5
Addrts,. 12 o 16a� c;c� Qc).
i fib S\-\e\'bvh WI\ 9 8S a -4
2 ?once) 4+ 22017,is. Oco 10
L
EH APPROVED sco.k: 1' _ )00'
Rhonda Thompson 04/07/2023
-ZId 2o22.-ota34-{
� 10/06/2022
• APPROVED
MASON COUNTY DCD PLANNING
SCO T ZUEDY,AICP
141,
■ ■ Digitally
• Ex;Shclq Rued signed
Shoo .. \Aell
��,. by Scott
4 v Ruedy
r iark,
D-8e x
•
Or4utic C-GI
I?/Scr/ DYG.k,raL 1
IN
RR5 Zoning
Front Yard Setback. 25'.
OQ
Side & Rear Yard Setbacks. Residential dwelling
and accessory structures is 20'.
• OR 10%width of lot if not more than 100' wide
j OR approved ADV •
•
No Development/clearing within 250'of Wetland
area without a Wetland report in compliance with
8.52.110