HomeMy WebLinkAboutBLD2023-00385 - BLD CD Environmental Health Review - 4/18/2023 z` <\`''''`''-',\:,� MASON COUNTY COMMUNITY SERVICES Permit No:�IG( ZOZn•(X)i7Sf?
/ C PERMIT ASSISTANCE CENTER:
' •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
.j 1- 615 W.Alder Street,Shelton,WA 98584 RECEIVED
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Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone 16
>)i,` .Y Belfair.(360)275-4467•Phone Elma:(360)482-5269 VO ! % APR 12 2023
BUILDING PERMIT APPLICAT if: 6 5 W Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR 1.o F�� T !N:
NAME: et a/U'
C} e i f W W . (a2 LCPn NAME: - L m
MAILING ADDRESS:1 PO 15 a x' Z 77.-- MAILING ADDRESS: Z
CITY: 51 ed1SPoa- STATE: !/�JA- ZIP: 9b'SS`8 CITY: STATE: ZIP:
PHONE#1: 6,o 2.Z 0 7 / PHONE: CELL: = 73
PHONE#2: EMAIL : rn
EMAIL: &o 3RuRc 300 G -1 v - I Ce" L&I REG# EXP. /_/ 3> Z
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑ = rn
NAME elI2M?if g att f f EMAIL '7
MAILING ADDRESS / ,O J J< Z72-- CITY 17v01 .oc7.-tr¢- STATE Itroi ZIP 'l ,S 7L-j
3 Ga o 'Z2 9 0 6'7 I CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 02.)-O 30 — /Z - 6100/Z ZONING 12ct rta 1 5
LEGAL DESCRIPTION(Abbreviated) h t 2. a ( 5 P '3132- 1-f' 2/VZ792- FIRE DISTRICT II
SITE ADDRESS 56 3 L 56- /3rz ca cQt c., /20 4 00 CITY S//G?Drl
DIRECTIONS TO SITE ADDRESS- 5,6, rn is I e S 6 u)-- ,4 2cac�c, (&.A(N -I-.A.i2 tz t S tom' Cl r''
/rl i c k di'e ( l20 6??zi v AT) Se co rr o Lo+ o w L e4't
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO 0'
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND ❑ SEASONAL RUNOFF❑ STREAM Er-.
TYPE OF WORK: NEW[t•f". ADDITION❑ ALTERATION[ REPAIR OTHER ❑
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USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) iO /MP/• (c,c .)
IS USE: PRIMARY ❑ SEASONAL[r NUMBER OF BEDROOMS / NUMBER OF BATHROOMS
HEATED STRUCTURE?�/ YES(Whole Bldg) ❑ YES(Part(sl of Bldg). { ' NO ❑
DESCRIBE WORK Att./ S// t;o P lr' ArCi1a me
SQUARE FOOTAGE: (propose+existing) TM AL i Dill N
1ST FLOOR_'1V`-t_sq.ft. 2ND FLOOR 313 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft. N
DECK sq.ft. COVERED DECK 33(..t sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE I W1(0_sq.ft. Attached N Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACT TION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL AR LENGTH 1
WID BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: r
SEWAGE/SEWER SOURCE: SEPTIC g, SEWER❑ / NEW X EXISTING❑
PLUMBING IN STRUCTURE? YES gr NO❑ If yes, attach completed Water Adequacy Form C .
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NO EXISTING SQ.FT.
EXISTING BEDROOMS PROPOST DItEDROOMS / TOTAL BEDROOMS 7
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
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Planning Setbacks „ Q
Front:25' i i n
Side: 20' EH APPROVED Z1N
Rear: 20' Rhonda Thompson 05/03/2023 W ' 1E
*all setbacks measured from the farthest 1- 00 fa
projection of the building CO
EH Setbacks
`subject to EH setbacks ci N
4 A.) Drainfield/Reserve requires 10'setback from footing/foundations ` N h O
B.)Septic tank(s)requires 5'setback from all footing/foundations ` t
P L N'Approved C. No foundation/Perimeter Drains within 301t,downgradient of n N V
04/24/2023 Drainfield/Reserve area 0 .
D.)No Cut Bank(s)(greater than 5ff and over 45 degrees)within (()
Mason Courty Community Development 50ft,down gradient of Drainfield/Reserve area 0
Gavin Scouten Cl cq
All ChangesSubjectta-Approval N a
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