HomeMy WebLinkAboutBLD2023-00446 - BLD CD Environmental Health Review - 4/25/2023 909'''''.11.44:21 MASON COUNTY COMMUNITY SERVICES Permit No � 1I jC b (I
/^ PERMIT ASSISTANCE CENTER:
0 •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
.i(• •a 615 W.Alder Street,Shelton,WA 98584
y ;`y Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone APR 25 2023
!. 8elfair(360)275-4467•Phone Elma:(360)482-5269
•��,;>.tit R.:`'�Y
BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRA TOR INFORMATION:�,.
NAME: '12W 1t A•4)t� �i. t-ttZ) - NAME: }liti !-►L rr7 L I- e- z
MAIL iiA��DRES ::C5 ' MAIL R S: l GI 1 ) "y U
CITY:II��Uj'l 1 y'.TA E:VV ZIP:`� CITY:I',k' Orli 1TE:( ZIP:
PHONE#1: L.• �J O- �1/ 1 - 7 13 S PHON �))' �. • 1, ELL:
PHONE#2: �'' )q- �i,,�r' EMAIL Lei I i9V'1 Lt c i e GC'lilt//leo db. 'r'Yr) =m O
EMAIL: L&I REG# V A EXP. / /_3 D
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHE � LI ���
NAME T�I/C. ✓rh, EMAIL'OiIt iri' /fI't -1.. ir)( ir' �/y7"•1 m
MAILING ADDRESS CITY. STATE LZI'� S
PHONE CELL :�• 3 . _
PARCEL INFORMATION: AA Al +
PARCEL NUMBER(12 Digit Number) /✓1✓1 A l -31" c1 DX' 31 ZONING
LEGAL DESCRIPTION Ableviat d)j_I,�V' or cit (-LET o i o f'; FI DIST C ��41 1�
SITE ADDRESS : IlJ E V'U1 yr •1 #�L1�0
DIRECTIONS TO SIT ADp ESS e.• l fi , L 1 �� ,
73 'Pi
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO SNOW LOAD: psf n0 t—'
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): V�
SALTWATER❑ LAKE 0 RIVE CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW'ADDITION 0 ALTERATIONL R.
REPAIR 0 OTHER 0 c�
USE OF STRUCTURE(Residence.Garage,Commercial Bldg,Etc.) J r K 2
IS USE: PRIMARY Elf SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 3
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Part[s]of Bldg) NO 0
DESCRIBE WORK
SQUARE FOOTAGE: (proposed)1ST FLOOR 7'/(a' sq.ft. 2ND FLOOR it
,g(3 . sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK t r �s(q.ft. COVERED DFCK((A(30.
1 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE .�.17 sq.ft. Attached[t Detached❑ CARPORT sq.ft. Attached 0 Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER❑ / NEW 0 EXISTING Q/
PLUMBING IN STRUCTURE? YES Er NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES PI NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS -5 TOTAL BEDROOMS
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 i1 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 <XVs.c\r •S' \t 'L ) Ar'N'-'..\L A 1 :)-5 i 1)-3
�9ignature of OWNER(Must be signed by the OWNER) IDate
,DEPARTMENTAL REVIEW. ..APPROVED -DATE DENIED .DATE. TAGS/NOTES/CONDITIONS:.
BUILDING DEPARTMENT 1
PLANNING DEPARTMENT
FIRE MARSHAL r / ' /y�
PUBLIC HEALTH �h /z?j Ct 1✓( ) Z-x-t!e 1
3
I . '
y. s.
F 1g 1 glii.lit :ii0 pif.,11 i i3O„,,,,,,t,:.e,,, „„! 1 i ii..44 .i..1 rii..,. ,„4
., .. . :.:. 6•it FR;.. 9.17.1)""i •-.g* I 14,,,,,,,,.:54.::;:y.,17,rlEespg, .. r •"'""'"---------7----.:;.1 a 7 ) !
f ti lig14111 liziligi;/1,1j f "e1`�$4t_. j4r 44 I t 11 i l: i il I i ill 1,1'Ii fI I; i I !!!
Is'
. f s . F !! , �
i_ . .. ......... Ioi" s:g=L � I � I ` ( ' v T � � Ilg rF•i I; i
I
I-Io1iIttJI1
cIhi
• s ii� � 4¢ iil
o a, r
rii,v T i='' j/ tjL_ fj
_
coa, mnim -^ 3N ? �\ }iorw 2
0
I
� w 3 g � m a(c •
�' �..• I , tit 4 —! )t
1 {t{t
00.651000 `� 1 �J�` .�--
Cr,-o o'o c`no �. r \ L t -1...........-... .--......_.-.....
w co
X o IF,c a su m m N o I ! \ --._-__.-----. O O ro cn T it
g�2 3 ��9.W J 2 I _.� I t ap .. .. r s � �7 37 d Cl O 31
\ �! g�� o m cn
'p a al (coN n', cr,, Q w o �—___ ! , tt! emasa ii g eQ'.: c� sp o
• t— o m N N w m fa,,= �_,_ I \\ ` ltq g-grits 1 att,. o ° o m n=-
�4 z m y N a N l I \ ! a 'l#eS : �: a�� m cfl
m < It! " Dw\ i S- , o -a
.J e �. <o ��
. y:c QN
• \- omwo]
s3-g r/ 45 +it7 m
�� / /n-� I 1 A .9 I. .„: S N
�i ^' t, �` I •
I —i is ; ). w m
S4.
N �- , r it I#� 111°p 8-
co
/J €( !---1-4-.---, L—, , §., 1 Li = ..i.i t J.: ' to ig45 g m
,, i . .. ;, ,, , (.... .....- \,,,. \ . ..i_t !,.,.. . -lc' : r„ ,„„ .,....,, , .
,„,...p. ..,, , i ,. ,, , .., ,., ,,..:.,i,„ • . ,..... .„, ,, . i '-e-g.-4 t'.:. k '
- �\ 3 a I
oid £ m 1 UJEtl € sr
'o 53d w t 1 1 at? l! e D
P_= + ,' t cn
OD
€ t cri
� \1 a �z1 O
.4,c -- 4 {'' - N
5 I' Williams Residence gy,' 80� N
PARCEL NUMBER: 12'121 31-JUU31 , 2s n- 'ao0
1 IN `,' 265E VICTOR RE), BELFAIR WA 98528 '` 0
z (3
z
z
illillitgiiNiteS611111111111111.11L 4111M100111011MBOINRIMINIC0 ailiaaa