HomeMy WebLinkAboutCOM2021-00089 - COM CD Environmental Health Review - 10/5/2021 1 t , ,' ' ''t-tt.;. MASON COUNTY COMMUNITY SERVICES Permit No: eAvY) 2,02J -r 9
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PERMIT ASSISTANCE CENTER: _
•BUILDING •PLANNING •PUBLIC HEALTH•FIRE MARSHAL (� 1\/
•I !* 615 W.Alder Street,Shelton,WA 98584 tJ 1 V
.: r Phone Shelton:(360)427-9670 ext. 352•Fax:(360)427-7798 Phone n C l Q 5 2021
:,.. Belfair:(360)275-4467•Phone Elma:(360)482-5269
�� - BUILDING PERMIT APPLICATION W Alder Street
PROPE INFORMATION: CONTRACTOR INFORMATION':
CIAZSICA £k 7S0/U NAME: /N/'i CvS7d� ii :(
M• .I ING A DRESS: /.0, €O X 2 2- MAILING ADDRESS: 306 Gv,S /Ai& 5a
CITY: 6IG,9/2 STATE: ZIP: CITY:/< 70/0 STATE0/4 ZIP:9,94 .6-7
PHONE#i: 3&0- S 5/- I9 PHONE:206-5/3-¢ t L,L:
PHONE#2: // EMAIL :Di'€COtI /'a/0/ef 7t274v ern •e41'Yi
EMAIL: /`/PtP3 1 &hit// /(' (ono L&1 REG# Rig//UC)98$Z/k 1 EXP. / /
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER[
NAME 0.1n-L/4* GO77G/P Mr.9 /0 /U DAid_ EMAIL i raik. O7`i`/k 0 /e/a0e24P• Z/2
MAILING ADDRESS/Sit/Dr TQ/J C002-7/ CITY D/t) STATE,/I//}- ZIP 9fi�.Slp
PHONE 2 --a12-5, // CELL Z06 -6/2^ " //
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) /220931-9O0W ZONING -2/0
LEGAL DESCRIPTION (Abbreviated),/tealf J TR4L7,S, 5la go FIRE DISTRICT
SITE ADDRESS/Z/ �f Qom'/L /lLt ' CITY ‘/Y1. /iM,
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO ❑ SNOW LOAD: Z.5 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑
TYPE OF WORK: NEW ❑ ADDITION ❑ ALTERATION [REPAIR ❑ OTHER ❑
USE OF STRUCTURE (Residence,Garage,Commercial Bldg,Etc.)
IS USE: PRIMARY ❑ SEASONAL ❑ UMBER OF BEDROOMS 0 NUMBER OF BATHROOMS
HEATED STRUCTURE? YES (Whole Bldg) [[YES (Parris]of Bldg) ❑ NO ❑
DESCRIBE WORKCO/VU' 0-Cilz lessA27 gGD6 7r co 774 //VUSyQ) 6y/z/
SQUARE FOOTAGE: (proposed) EXtS4-t n 4-(00 15 cLueiact-Ceti t- �e-•
24Z- w�C1- 4n L.-to gnclo5Ed ap
3RD FLOOR s . ft. BASEMENT sq. ft.
1ST FLOOR_ __sq.ft. 2ND FLOOR sq. ft. q
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq. ft.
GARAGE sq.ft. Attached ❑ Detached❑ CARPORT sq. ft. Attached❑ Detached❑
MANUFA ORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
M E MODEL LEN
IDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 1 SEWER❑ / NEW4 EXISTING ❑
PLUMBING IN STRUCTURE? YES V NO ❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NO❑ EXISTING SQ. FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS D TOTAL BEDROOMS Q
i p�yyNER adiriowlod'ges that Submission ot,nacuiralu information may roSult in a stop vrork order or permit revocation.AdtnwMec194rnent of such IS by
signature below.I declare that I am the owner and l 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 casement 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 rf work orauthorrzed construction is no:commenced within 180
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT ISBY MEANS OF INSPECTION. INACTIVITY OF
PERMIT A0 LICATION OF DAYS OF MORE
WILL
CODECOUNTY USE T
X THE
APPUCATION TO BE EXPIRED.(MASON'
14.08.42)
ure of OWN ( ust he alaned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DALE DENIED DATE. i i.GSfi oTES/CONDITIONS
r BUILDING DEPARTMENT
PLANNING DEPARTMENTI FIRE MARSHAL
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" RUDY &JESSICA WATSON
"i6e'w".,"'°.••. 121 EAST OUAIL HILL ROAD BELFAIR,WA 98528