HomeMy WebLinkAboutBLD2023-00277 - BLD CD Environmental Health Review - 3/29/2023 e�'"'" "L'�1t,4 MASON COUNTY COMMUNITY SERVICES Permit No: r,1(-1 2v77,-�'Q2r+t,i-
PERMIT ASSISTANCE CENTER:
` •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
rj 3 =. 'I!' r 615 W.Alder Street,Shelton,WA 98584
L�U i1 ,- .r
7 Phone She/ton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
MAR R 2 9 2023 '/ Bolfair.(360)275-4467•Phone Erna:(360)482-5269
BUILDING PERMIT APPLICATION
770 .1VED
' ' a ERTY OWNER I FORMATION: CONTRACTOR INFORMATION:
NAME: J7>1 /Vi/1�•t'ISO NAME: 0k--4 tev" L l iel"
MAILING ADDRESS: J.2,2_ S 7671,frAf/e MAILING ADDRESS:
CITY:�y29ldidee4 STATE 4- ZIP: G,'2o.1 CITY: STATE: ZIP:
PHONE#1:(II g toe,- , s/ 2 2 S PHONE: CELL: (Tl
PHONE#2: f EMAIL: Z
EMAIL: "I/0.2/l'%Sf[3 62 c dI•/OK•1 L&I REG# EXP. / /
• L4 PRIMARY CON_ __ TACT: OWNER 0 CONTRACTOR❑ OTHER IT /�laP`f 7 _ 73
r NAME / // !/� ( ,'GLL EMAIL (V/
^\-. �1� MAILING
AILI GADDRESS 3t9/S S /Ill CELRQi, CITY — STATE ZIP p2 z
PARCEL INFORMATION: —7 �j / Ell
PARCEL NUMBER(12 Digit Number) 3 e t ' —52 -r'c'`yf ZONING = z
LEGAL DESCRIPTION(Ab ceviated1/ 7 /s FIRE DIST,R CT
SITE ADDRESS 1 / /f/. fi (/ CITY L/.7/, Gtfl1/
DIRE�9 NS TO SIT•ADD Ss Wit l / p/1ICrna_ f'. a, r—
LaffOBI . ( A-- (/ 4, f LL//
IS THE PROJECT WITHIN 3000 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO E(SNOW LOAD:7f psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW( ADDITION❑ ALTERATIONw 0 REPAIR 0 OTHER ❑
/
USE OF STRUCTURE(Residence,Garage.Commercial Bldg,Etc.) ' '/44
IS USE: PRIMARY 0 SEASONAL, . NUMBER OF BEDROOMS � NUMBER OF BATHROOMS 02
HEATED STRUCTURE? YES(whole Bldg)0 //YES(Parr�hh]o(Bydgt q NO 0 L
DESCRIBE WORK 5/) 9 li= /zf,{ly it (/ii- '/%,L
SQUARE FOOTAGE:(prpa..<d) 4Q4j!/S 72-6 l/C,t" -14Q 6-4,14...
i
1ST FLOORI0W sq.ft. 2ND FLOOR
C ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK-S..S ?sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE. WY sq.ft. Attachedg Detached 0 CARPORT sq.ft. Attached❑ Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEA TH
TH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: /eel? �
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEW 0 EXISTINGGJ�,/��
��%PLUMBING IN STRUCTURE? YES 2e- NO 0 If yes,attach completed Water Adequacy Form
•
PERIMETER/FOUNDATION DRAINS PROPOSED? YES NOD EXISTING SQ.FT.
EXISTING BEDROOMS G PROPOSED BEDROOMS 2_ TOTAL BEDROOMS t..2_-
OW NER 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 it 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 APPLICA N OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
r
—1 X �/� `�-- !— �'— Z
Signature OWNER(Must bSsigned by the OWNER) ' Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL In ,
PUBLIC HEALTH C)J ' ql•L) L0.1.3 C(14-4g-,
EH Setbacks PLN Approved
A=.Drainfiekl/Reserve requires 10'setback from tootingtloundaSons 04/19/2023
B.)Septic tartars)requires 5'setback from all footing4oundalions EH APPROVED
C.)No fourdatioNperimeter Drains within 3011.downgradient o1
Drainfield/Reserve area Rhonda Thompson 04/27/2023 Mason County Community Development
D.)No Cut Bank(s)(greater than 511 and over 45 degrees)within Gavin Scouten
Spry,down gradient of Drained&Reserve area
d All Changes Subject to Approval
.14 Planning Setbacks
Front: 25'
Sides: 5'
/ Rear: 10'
'all setbacks measured from the farther
/ .. projection of the building
j / *subject to EH setbacks
16. /* \ 41
sFj
' 6,4 �103 .i 4GP
,
lyilliiir_3v .I Al�� O XN
/
.1,, "mill
i/ '' • goo.ir
a ,.\ J
,� ; �� �n LOT 4 3�I
L. I i �- Reserve area
III. .__. DRAINFIEL
O
a
J IX SEPTIC
TANK
(oT 42
0
IVI 2623 - OD.Z
-0- SITE PLAN SCALE: III = 10'