HomeMy WebLinkAboutBLD2023-00130 - BLD CD Environmental Health Review - 1/31/2023 ` 1 D20 3 -Co 1 3 0
MASON COUNTY COMMUNITY SERVICES Permit No:�3
`� PERMIT ASSISTANCE CENTER: ^
/ t•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL ^y\� ,h1.J[�
• -` I 615 W.Alder Street,Shelton,WA 98584 f�J/`' c
t\\+- __.. j' Phone Shelton:(360)427-9670 ext. -Fax:(360)427-7798 98 Phone
`
Belfair(360)275-4467•Phone Ekna:(360)482-5269
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`/ BUILDING PERMIT APPLICATION 67 Jq'r
PROPERTY OWNER INFORMATION: ^CONTRACTOR INFORMATION: • 0?�
NAME:F �}t- S12.&lam- NAME:
MAILING ADDRESS:5Rt2 N�• 'C VII MAILING ADDRESS: St cat
CITY:M?ttV 'ESL STATE:;r.11A ZIP:gg-ldr CITY: STATE: ZIP:
PHONE 41: "2 to- Syl - . 1� 5'‘<1- PHONE: CELL:
PHONE#2: EMAIL: eL4CI,EMAIL: _{EC*S�,.lsrtx'�c� 1��fXcC n.I_&I REG# EXP._/_/ or A 1
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER 0 Ot • I
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE _ CELL 4 j/ /44
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number)_! `Q\.D ` ,7....--000`o ZONING
LEGAL DESCRIPTION(Abbrcviatc. FIRE DISTRICT
SITE ADDRESS .5:A�Z \rc E -Qrts..ls�.ic CITY �j �- (sJ
DIRECTIONS TO SITE ADDRESS `i
IS THE PROJECT WITHIN 300 17T OF SLOPE(S)GREATER THAN WY.: YI-S❑ NOO SNOW LOAD:, psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all Mai apply):
SALTWATER❑ LAKE❑ RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEWX ADDITION❑ ALTERATION❑ REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence.Garage.Co,rn,n ,I pug.Do G,r c-t-4-3Q I c err"V 1-1%-
IS USE: PRIMARY❑ SEASON ALL NUMBER OF BEDROOMS NUMBER
NUMBER OF BATHROOMSA
HEATED STRUCTURE? YES(note Bldg)0 YES(Port151ojatdg, NO2e1 . - t_ el
DESCRIBE WORK •��--
SQUARE FOO_TpAGE:(premed)
1ST FLOOR 1.7ZZsq.R 2ND FLOOR1,)Zg sq.ft. 3RD FLOOR sq.It BASEMENT sq.ft.
DECK sq.ft COVERED DECK K-7C:::)sq.ft. STORAGE sq.ft. OTI1ER sq.ft
GARAGE sq.It Attached 0 Detached 0 CARPORT sq.ft. Attached❑ Detached❑
- -1(4.24%.1 : ANUFA NFORMATION: *4 COPIES OF TILE FLOOR PLAN REQI ED*
MAKE ��1 V`b MODEL. —eC t La YEAR 20 23 LENGTH 431
WIDTH 312 BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC . SEWER❑ / NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES' NOX If es,attach completed Hater Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YESS NOD EXISTING SQ.FT.
EXISTING BEDROOMS _ PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER acknowledges that submission of inaccurate information may result in a slop work order or permit revocation.Acknowledgement of such is by
signature below.1 declare that I am the owner arid!further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from ali the necessary parties.Lncludmg 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 vrithin 180
days or f(construction work is suspended fora period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT_RPPLICATION OF 80 OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X -. -)3 /'2-5;Z�
Signature of OWNER(M st be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES./CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL //��[� p )_t �/J �J
PUBLIC HEALTH _ // ) `11I fia/Zi _ NI Il+(YIt Deed
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5 7,2:( �c\ckrN►S R
EH SETBACKS
A)Dralnheld/Reurve requires 10'setback from footing/foundations
8)Septic tanks)requires 5'setback from all footing/foundations
• ^� Q No foundation/perimeter drains within 3D dowmgradient of dralnfield( .
r O/ mr,eaea
D)No cut .baNds)(greater than 5'&over 45 degrees)within SO'
•
I N dowmgradienl d drnnfKld/resene area
..,,� �'(;1 EH APPROVED
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OD1 RECEIVED
•
�H. JAN 31 2023
toy. N . "" 615 W. Alder Street i.
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