HomeMy WebLinkAboutBLD2023-00338 - BLD CD Environmental Health Review - 3/29/2023 ` � s � MASON COUNTY COMMUNITY SERVICES Permit LQ20 0033
r PERMIT ASSISTANCE CENTER:
;t;•BUILDING•PLANNING•PUBLIC HEALTH.FIRE MA)f2SiIAL.- Q c...
615 W.Alder Street,Shelton,WA 98584 ` ��
J -s z Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 i 2 8 2t 23 ENVIRONMENTAL
?F .- Belfaic(360)275-4467•Phone Elma:(360)482-5269 1'1r't, HEALTH
BUILDING PERMIT APPL4G6TIpkiler Street
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PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: 1 `C.)T44 ct1N cJ .rti L NAME: SA OA t _
MAILING ADDRESS:PO No x y MAILING ADDRESS:
CITYUj Av.n,A STATE: A ZIP:`t3.3' S CITY: STATE: ZIP:
PHONE#1: ZS 3-S.`I cl-S-- O PHONE: CELL:
PHONE#2: EMAIL: n
EMAIL: Gy% e p e 0 7 a t^oz.,.c ::•--• L&I REG#CCPO�2Ccr(�`3SC G EXP. H /I tj/1-3m 3 g
PRIMARY CONTACT: OWNER'- CONTRACTORg. OTHER 4h
NAME P\ik2 A 2v.•,Ai CC_CC_ EMAIL ''eke-(l\ 0 y ` _ v ,
MAILING ADDRESS PC 6 O,c / CITY 1 1%•.t h SPATE LAI A ZIP 1 e StS c.
PHONE CELL 2S 3-S 19 - 51 1 O
PARCEL INFORMATION:
i PARCEL NUMBER(12 Digit Number) 1233 0 3:?..ci 0 2 ln1- ZONING
LEGAL DESCRIPTION(Abbreviated)4_e T 2 MS#1179 Gem Lrr3 jt-23•i FIRE DISTRICT
SITE ADDRESS V. E_ •1-/Lvi:r K D2 . CITY k 4uL
DIREC/T(ONS TO SITE ADDRESS Ai, • i2 t` N 1 v CL.e'i t e 4 —bo 2.
k.1--) c J 1,cvi.z. I1 R crt, CytA;COK • Lc.T CN IC
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO Ge SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER D LAKE 0 RIVER/CREEK❑ POND❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEWS- ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)g YES(Pan/sJojBldg)D NO❑
DESCRIBE WORK N E W F
SQUARE FOOTAGE: (proposed)
1ST FLOOR`i`i 0 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK IL( sq.ft. COVERED DECK 200 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE i O C' sq.ft. Attached Zr Detached 0 CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION:` *4 COPIES OF THE FLOOR PLAN REQUIRED•
MAKE MODEL Tom+`� YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC r SEWER 0 / NEW K EXISTING 0
PLUMBING IN STRUCTURE? YESX NO❑ Ifyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO+� EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS 3
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) :
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
PUBLIC HEALTH wr `ti27 /js .„'Ls cva,s
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