HomeMy WebLinkAboutBLD2023-00304 - BLD CD Environmental Health Review - 3/17/2023 • t�•0"'' ''`""•'a;. MASON COUNTY COMMUNITY SERVICES Permit No: fJ g CI ZD2?J • 00 �.
PERMIT ASSISTANCE CENTER:
T .BUILDING•PLANNING•PU8L1C HEALTH•FIRE MARSHAL RECEIVED
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I• 615 W.Alder Street,Shelton,WA 98584
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a. '<,1 i Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
u Belfair.(360)275-4467•Phone Elma:(360)482-5269 MAR 1 rho I/� I/�/S�
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BUILDING PERMIT APPLICATION nnJJ,,,�� z
PROPERTY OWNER INFORMATION: CONTRACTOR IP`'� 1arI014Ner Str= '�
NAME: a')IYl f 1O(�i �!. NAME: G _ •.
MAIL ADDRESS:‘ o/) # I C�• 2 . MAILING ADDRESS: .0 I►S
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CITY: )I Ltl_`11. STATE: t j ZIP: jF, Y-,1 CITY: STATE: ZIP: ,►
PHONE#I: 3110• &)I • s,71(.r PHONE: CELL:
PHONE#2:_ EMAIL:
EMAIL: . Lo I ablet-LCC.,
AV REG# EXP. / / = rn
zPRIMARY CONNTA OWR 0 CONTRACTOR 0 OTHER 0
NAME `t1 L4 ill k 1 EMAIL D
MAILING ADDRESS CITY STATE ZIP r
PHONE CELL
PARCEL INFORMATION:PARCEL NUMBER(12 Digit Number) 1 " T((o ' O('1)C C
5() ZONING KK •
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 300 E. Af)p6.,I D( )A t L • CITY S r i ks,a
I C�TIONS TO SITEADDRESS
IL Y_('1Ll.v Ve l, OW Tie ey - Is' G�Ir. , At �i L y� >� C. Oa� lr1-12-
IS THE PROJE J WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO❑ SNOW LOAD:_psf "��IQ«1 I
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): I (-IL''
SALTWATER 0 LAKE 0 RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF❑ STREAM 0 1- Y1_ ,,-1•
TYPE OF WORK: NEW, ADDITION❑ ALTERATION 0 //!�REPAIIR 0 OTHER 0 V j De_ •
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) d lt�
IS USE: PRIMARY SEASONAL 0 NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Pants)o Bldg)0 NQ 0
DESCRIBE WORK fle i'1L - I.t..`tat--
SQUARE FOOTAGE:(proposed)
1ST FLOOR 5 r3 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached 0 CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE Via.( I C.di) MODEL l,.'/I) I?J to> YEAR 2(,)a-i) LENGTH 51-1
WIDTH I"/ BEDROOMS A BATHS t SERIAL NUMBER -r D
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ I NEW EXISTING 0
PLUMBING IN STRUCTURE? YESX NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATIOI/ 'DRAINS PROPOSED? YES❑ NO,Q EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 2 TOTAL BEDROOMS 2—
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)
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Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL f .,�� _ _
PUBLIC HEALTH O yp{1 A lU4VZ) C' � J CCS-,�`n
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rTCEIVED
N}AR 16 2023
615 W. Alder Street
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