HomeMy WebLinkAboutBLD2023-00251 - BLD CD Environmental Health Review - 3/6/2023 ,. .0:`�?'-1 MASON COUNTY COMMUNITY SERVICES
t" Permit No S '
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� PERMIT ASSISTANCE CENTER:
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•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
5, )�. 615 W.Alder Street,Shelton,
r = r-~• �' WA 98584
t;'t:- 4 r,� Phone Shelton:(360)427-9670 ext.352•F
thb� Bellair(360)275-4467.Phone E/ma.;(360)4 82-5 2 6 98 Phone MAR 0 6 2023
BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION:
CONTRACTOR INFORMATION:
NAME: f. 0
MAILING ADDRESS: _ D NAME: V,,r c (�
CITY: MAILING ADDRESS: 'CuZI
PHONE#1: -� STATE ZIP: CITY:
STATE:CELL: ZIP_v A p ri
PHONE#2: PHONE: /I
EMAIL: ►1 IQ V T!?t /!� ✓1�c�t EMAIL. 7 ZO?3 i
L&I REG# •
PRIMARY CONTACT: OW12V1 EX'•— IVEp
NAME
EMAIL
NE CONTRACTOR❑ OTHER❑
MAILING ADDRESS ^�
PHONE CITY STATE ZIP rn
CELL 2�,f ?�; _ Ly
PARCEL INFORMATION: D
PARCEL NUMBER(12 Digit Number) —. / _ —� m
LEGAL DESCRIPTION 3 ! l l[�r�i '� ZONING-S(Abbreviated) M
SITE ADDRESS 1,1%) ; 72 h . FIRE DISTRICT
DIRECTIONS TO SITE ADDRESS CITY
i, •cam _ �s+t.Z- — C.
D
r
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14"/0: j r -
A.
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: YES NO SNOW LOAD: Z�psf
SALTWATER�] LAKE❑ RIVER/CREEK (Check all
❑ POND 0 WETLAND, SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK:
NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Re idence,Garage,Commercial Bldg,Eic,)
IS USE: PRIMARY SEASONAL
❑ NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)111 YES(Parrfs)of'Bldg) NO •
DESCRIBE WORK r ❑ ❑'A /)
----4 IC CU SOUARE FOOTAGE:(proposed) 1.....
1ST FLOOR sq.ft 2ND FLOOR' •
IrTib sq.ft. 3RD FLOORJ/O sq ft BASEMENT
DECK sq.IL COVERED DECK sq.ft.
GARAGE 3 46 •i.fI. STORAGE_VQ_sq.ft. OTHER
sq.R. Attached❑ Detached O. CARPORT sq.ft.
sq.ft. Attached❑ Detached❑
MANUFAC . ' .1 HOME INFOR` • I N: *4 COPIES OF TIIE FLOOR PLAN REQUIRED*
MAK MODEL me
• DTH BEDROOMS LENGT
BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW� EXISTING❑
PLUMBING IN STRUCTURE? YES❑ • NO
0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES
0
NO❑ EXISTING SQ.FT.
EXISTING BEDROOMS_
PROPOSED BEDROOMS J TOTAL )
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.BEDROOMS Acknowledgement such is by
signature below.I declare that 1 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
and
rstructure(s)fo
resents that and inspection. This perm t/application becomes the information provided is accurate and nnull 8 voidees if work orofs aon uthorized coCounty nstructti nss toeisabove described not commencedpwtth n n180
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)
Signature of OWNER(Mstu be signed by the OWNER) ����
Date
DEPARTMENTAL REVIEW
APPROVED DATE DENIED DATE TAGS.MOTES/CONDITIONS
BUILDING DEPARTMENT111111111 —_
1111111111111111111111
PLANNING DEPARTMENT11111111111 —_
PUBLIC HEALTH , c+ __jJ-
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