HomeMy WebLinkAboutBLD2023-00339 - BLD CD Environmental Health Review - 3/28/2023 •
(O.-9-44, MASON COUNTY COMMUNITY SERVICES Permit No: «1 ) �`"
PERMIT ASSISTANCE CENTER:
Y c r��'D
l Y. •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
615 W.Alder Street.Shelton,WA 98584
'-- .4 Phone Shelton:(360)427-9670 ext.352•Fax (360)427-7798 Phone MAR 2 8 2023
�y'' nr. Bel/air.(360)275-4467•Phone Elma:(360)482-5269
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BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: (111k e g3 .L Ad iu Z< NAME: P p ON. Q.c+N ..A
•r et14(D =l'L m
MAILING ADDRESS: PO 83 t' .K t/ MAILING ADDRESS: 10 &X ' T.:.
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CITY:k)/iv.NA STATE: iN 4 ZIP: 'j13y S.- CITY: 1Ad A u1/4,J A STATE: - A ZIP:'jR :3 c)S'
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PHONE#1: 2S3.S`i9- 5760 PHONE:1-S1'Sti`!-S7Z�ELL: SA«vC Imot
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PHONE#2: EMAIL: k • s h c c , CC ti. n 3 -•a •
EMAIL:�`s,�C Z _ • kee , C e i'v L&I REG# ( C. til. 5C..... EXP. y /.1 Y/J < I.,S 111
PRIMARY CONTACT: OWNER CONTRACTORS OTHER❑ C/ N r-
NAME Yti.k< k3r.,.rrNz,t EMAIL mt\.t Q % C'' AkCC , :C^^ w� '-
MAILING ADDRESS t'( PA,x Li CITY CITY , e,�"A STATE Il A ZIPS((E3' s .
PHONE CELL 2.S3• S`191- 57eO
PARCEL INFORMATION: �j _ `i
PARCEL NUMBER(l2 Digit Number) 1 a- 3 O t 2 ZONING �'l�`� r
LEGAL DESCRIPTION(Abbreviated) LG'T'y sec jet Tev.N 23 4:."r4 f r(uti I WIRE DISTRICT
SITE ADDRESS 6.U IJ C- St. 1'1l-z tt,Rs CITY 13:1T R 4,4 tA `IF52 6
DIRECTIONS TO SITE ADDRESS N Ss c:C 2 0 ?" t S S t 0/4 ('L<e.k f-, t'1 T"I- o r2
TO l t tt e•ru �a eitNt
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO 21 SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEWS' ADDITION 0 ALTERATION❑ REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc.) F R
IS USE: PRIMARY SEASONAL 0 NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS .2.
HEATED STRUCTURE? YES(Whole Bldg)[a YES(Part/a]of Bldg)0 NO❑ 414e•r". 7 44s1t 1t"„+.T.,
DESCRIBE WORK i ►.i 1'iy0 i` F . (-' R. — Mc-- !ix uc\t w•pZ tr4tarit
SOUARE FOOTAGE: (proposed) -?iTiaCt-IYLL&L-j - C'.ir)t-'t:I(L. I 0 t-61 fie ill
1ST FLOORIO sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK Xil sq.ft. COVERED DECK.)f)0 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE 00 sq.ft. Attached ly Detached❑ CARPORT sq.ft. Attached❑ Detached 0
MANUFACTURE HITIM INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*RE
MA MODEL �-+ n
WI6TH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEW 0 EXISTING 181
PLUMBING IN STRUCTURE? YES W' NO❑ lfyes,attach completed Water Adequacy Form
i PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NO EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 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 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)
X fl\ ii,�...----Z .2-,4,, - 23
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 � r�^
PUBLIC HEALTH Q,e I � � `t'C A'--) .49W
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