HomeMy WebLinkAboutBLD2023-00313 - BLD CD Environmental Health Review - 3/21/2023 J
MASON COUNTY COMMUNITY SERVICES Permit No:Jj�j l'`-
Permit ' -CO iJi I
.z--. ,.., PERMIT ASSISTANCE CENTER:
d. •BUILDING••PLANNING••PUBLIC HEALTH••FIRE MARSHAL
r 615 W.Alder Street,Shelton,WA 98564 RECEIVED
GS` ��'/ ;` Phone Shelton:(360)427-9670 ext.352•Fax:(3604427-7798 Phone
�'' Be/fain(360)275-4467•Phone Elms:(360)482-5269
t . MAR 2 0 2023
Q .,
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION. it •q Street
NAMELBr 1YA{� NAME:
MAILING ADD S : S-S=(Q 04_00*Srei'1 MAILING ADDRESS: A
CITY: l ;t 4) /STATE: ZIP: 4 4,y2<,' CITY: ATE: ZIP: 'J�
PHONE#1: /5 3 - a9 x- 510 06 PHONE: CELL: plIN r
PHONE#2: 10 G -i el&-bpi E•l 4.e4'' EMAIL: C'
EMAIL: L&I REG# EXP. / '
PRIMARY CONTACT: OWNER lia' CONTRACTOR 0 OTHER 0 a
NAME Pt('v rvr4 YGI-ff i; EMAIL y A-te , h�'ehsit C`) ?i yi.r -''_�C-.
MAILING ADDRESS .i%4(:U itc ft,�'-rh 5h�t E ea CITY (3c I.C�z.d STATEt CI ZIP 456--
PHONE ?=;1 3 !1 c("4.- cSc c. CELL M
PARCEL INFORMATION: z.Z..r I O 'c�t V�5l ' �� i �j, Z
PARCEL NUMBER(12 Digit Number)VOA> -C�j (— On t ' ZONING i 19 - 5
DESCRIPTION(Abbreviated)5i b " -- FIRE DISTRICT 2 -r Do
LEGAL `sr �SITE ADDRESS 5-2,-1O C1 F,Vtc4-m `•�hc1 e t2_LA it CITY (•_k.cl—c r rl_ J
DIRECTIONS TO SITE ADDRESS T-' Z
7
�� G
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YE'S�J�" NO 0 SNOW LOAD:2 1psf --- T
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check au that apply): -7
SALTWATER❑ LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW ' ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0 >
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) I.—
IS USE: PRIMARY SEASONAL 0 NUMBER OF BEDROOMS I NUMBER OF BATHROOMS I
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Part/s)of Bldg)' NO 0
DESCRIBE WORK V ELA) SFE.. -
SQUARE FOOTAGE: (proposed)1ST S.O
1ST FLOOR ` sq.ft. 2ND FLOOR L sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK 212±)sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft
GARAGE7(a, sq.ft. Attached Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED . •ME.33EORMATION: *4 COPIES OF TIIE FLOOR PLAN REQUIRED*
MAKE MODEL R LENGTH
•TH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: v
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEW j� EXISTING❑
PLUMBING IN STRUCTURE? YES X NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES' NOD EXISTING SQ.FT.
EXISTING BEDROOMS D PROPOSED BEDROOMS I TOTAL BEDROOMS 1
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 descrioed property
and structure(s)for review and inspection. This permit/application becomes null 8 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)
Signal re of ER ust be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL CCU! '�-'\
PUBLIC HEALTH Lk i rl-�� d.!" , a
t
Site Plan
1 NN
re a � �� W + E EH APPROVED
12� ,, A � } Rhonda Thompson 04!14/2023
is.
'A S
W�° ili
TD Ict 2023 -- 003 1 3
3
m
EH Setbacks
A.) Drainfield!Reserve requires 10'setback from footing/foundations
8.)Septic tank(s)requires 5'setback from all footing/foundations
100' Wide C.)No IoundationPerimeter Drains within 30ft,downgradient of
Drainfield/Reserve area
�^ D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within
200' Deep Proposed 50tt,down gradient of Drainfield'Reserve area
20'Tu prop hne,
Residence
28'x 30'
647'Total
To back of I
property �o'Deck Scale. 1 " = 40'
of
`1 Block Wall
Brenda Yates
5840 NE North Shore Rd
z°'x8'Storage Belfair, WA. 98528
22210-51-00906
Colin
Septic to x 12'
Drain Field I
RV Pad
pfiveW M
NE North Shore Rd