HomeMy WebLinkAboutBLD2023-00070 - BLD CD Environmental Health Review - 1/19/2023 ._•c>-''G.r�".:12 MASON COUNTY COMMUNITY SERVICES -' � c�. -C)cx '10
• 'lrt• PERMIT ASSISTANCE CENTER:
y. f+: •BUILDING•PLANNING•PLIBLC HEALTH•FIRE MARSHAL
..
F - I 615 W.Alder Street,Shelton,WA 98584 J A N 19 2"3
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y.,r,•a""+ �, Phone Shelton:(360)427-9670 ex[352-Fa>r(360)427-7798 Phone
y Beltair:(360)275-4467•Phone Elma:(360)482-5269
g•rf,. r'�. . 5 W. Alder Street �`Z BUILDING PERMIT APPLICATION I
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Po oaf M rr Go i i 6 NAME: j 2
ADDRESS: f 2 '() gg F'IQC.(4J(,er) MAILING ADDRESS: rn
CITY:J j.1 (gin) STATE: W I) 11P: LtI ut y CITY: STATE: ZIP: Z
PHONE#1: 5 63 -9 q 5- 13 5y PHONE: ('FI.I:
PHONE#2: 11, 11 • EMAIL: •-^
EMAIL: P�6i(r cpmdin)e U:Vp , /•) '\ I 'T REG# EXP. / / = Xi
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r
PRIMARY
� CONTAC�T:: OWNER[ CONTRACTOR❑
NAME I" onal Inc(7U i C EMAIL t-"cI 1) WC•c'Cly im<Co'✓'PL (a)
MAILING ADDRESS 12 ?d S E F I R,€ WGG�f) KO CITY I4CL-17)'✓ STATE Wi J ZIP 10 a`I r
PHONE 5 O - 45 "13 s1'1 _ CELL m
• PARCEL INFORMATION: = Z
PARCFT NUMBER(12 Digit Number) 32O2G -q S - 9s 0 I(I ( ZONING R-4
LEGAL DESCRIPTION Abbrcviated) �j FIRE DISTRICT y r
SITE ADDRESS f 22150 . I^i lg.6WF>‘A AD CITY S 116 L.?O►✓
• DIRECTIONS TO SITE ADDRESS A Q.0 Q n I A 'TD E I l410 Si 14-•6 in ri IL&u. c8
IS THE PROJECT WITBIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES)] NOSI SNOW LOAD: nsf
IS PROPERTY WITBIN 200 FT OF LHL FOLLOWING: (Check ell That apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Raiaeece Garage,Cammesciel Bldg.E,a) ',([' , .
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEA L I;U STRUCTURE? YES(whole Bldg)❑ YES(Part[a]ofBldg)❑ NO r
DESCRIBE WORK')VT'tc.4,L F)X f-'.'1(_.Ott)L 1-1 T 1�'tl4.i'L • •:1I 1 i= -h.e c t eta i It Cif'-
• SOUARE FOOTAGE:(proposed)
1ST FLOOR IJ—t sq ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft •
DECK sq.ft. COVERED DECK K.ft. STORAGE sq.ft OTHER sq.ft.
GARAGE 1( !:+-.sq.ft_Atrnchedp Detached❑ CARPORT sq.ft-Attached❑ Detached❑ •
MANC FACTURFI2HA ON: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAW
gE MODEL LENGTH
TH BEDROOMS BATFIS SERIALNUMBER
•
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC•t" SEWER❑ / NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES)( NO❑ Ilya:,attach completed IParer Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YE NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPO SFn 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 at 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 aerate and grants employees of Mason County ar—e n to the above described property
and structures)for review and inspe tore This pennMJapplication becomes null&void if work or authorized constru o,•t is not commenced within 180
days or if co tstrudion work is suspendeds
sp for a period of 183 day
PROOF OF CONTINUA N OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT AP CAT N OF a DAYS OF MORE WILL CAUSE THE APPLICATION T BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X 1 /9 2-
Signature of OWNER(Must be signed by the OWNER) Date
.'•DEPARTiNiENTALREVE W S-;:;,APPROVED:-, DATE"-..:s DENIED ti.:.DATE"=TAGS/NOTES/CONDITIONS-
BUU DLNG DE.ART_ ENT
•
PLANNING DEPARTMENT
FIRE MARSHAL A
PUBLIC HEALTH •l / ih l}4 I ask/Cif ittl a(/i&7( •
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