HomeMy WebLinkAboutBLD2023-00434 - BLD CD Environmental Health Review - 4/24/2023 -G'' :', MASON COUNTY COMMUNITY SERVICES Permit No: , •:
PERMIT ASSISTANCE CENTER:
•BUILDING•PLANNING•PUBLC HEALTH•FIRE MARSHAL
F •,g 616 W.Alder Street Shelton,WA 98584 RECEIVED
>r r�� Phone Shelfon:(360)427-9670 ext.352•Fax: 60 427-7798 Phone
2
) "�y Beak:(360)275-4457.Phone Elm(360)482-5269
°- a APR 2 4 2023
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATI(5 W. A der__f: /-Ltd
NAME: .:Lt 'v
! L- 1 d 1 u�S NAME: "U
MAILING ADDRESS: '-t ►)f 1;,....iA,.,\I v, DMAILING ADDRESS: APR
CITY:
DONE#1: ,- ,/1_ .eATE:L -, PHONE: STATE:
CELL: RF S 2023PHONE#2: L;I-� -SSCI J l 'C EMAIL: CF/(/ •
EMAIL.:c"r v\t•\A ,�5-\e ..in r,1 ('..vx,�r n, ,,•,"Y�frT REG# EXP. / / �0
PRIMARY CONTACT: OWNER$. CONTRACTOR❑ OTHER❑ .53
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NAME LCE_t, 1�,.,t,) iZi'• ��t.L.�S EMAIL i tk, -1,-# A�-,_- rC,l•7 4.4.00 , C C�,-1--`l • T
MAILING ADDRESS `I t t 1 f— it Ai,.-,{'11,v• \f.L..1 CITY STATE L % `1 g-- YS 5 .fir
PHONE ''1<•f'r'-(.''()-- Li 4 t g CELL .�. .-` `Z 0 Cy_ • IT 0
PARCEL INFORMATION: G 7 Z
PARCEL NUMBER(12 Digit Number)Z2.Z,\ l .>i —(-)LQZS ZONING �.
LEGAL DESCRIPTION(Abbreviated) r� FIRE DISTRICT • Z
SITE ADDRESS Li61 v1( mC u:w�Cl In Ni ,{•.j c a CITY
• DIRECTIONS TO SITE ADDRESS
r
IS THE PROJECT WTTBIN 300 FT OF SLOPES)GREATER THAN 14%: YES❑ NO❑ SNOW LOAD: psf
IS PROPERTY 20 FT OF THE FOLLOWING: (Check allA.:apply):
SALTWAUr.R❑` LAICE RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NE WrA ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Reside..{Garage Commercial Bldg.Etc) (,\\.((r A(. C--
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OFBjDROOMS l NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(who,Bldg) YES(ParlfsJofBldg)❑ NO L..4 }-
DESCRIBE WORK �+cC y C(1'1.1\ri Gi 9 LJ)/ z _t-f- Ltij4 ,l f1/1 .ft.C�1
• SOIJARE FOOTAGE:(proposed) J
1ST FLOOR _.sq.ft 2ND FLOOR' 6--6-sq.f. 3RD FLOOR sq.R BASEMENT sq.ft.
DECK �/'' sq.ft. COVERED DECK .- sq.ft_ STORAGE 52-1 sq.ft. OTHER sq.ft
GARAGE Lr�,2 sq.ft. Af,rrhed❑ Detachedy, CARPORT`'Sh sq.ft.Attached'Detached❑
MAN[JFAC ORMATION: • *4 COPIES OF ALE FLOOR PLAN REQUIRED*
MODEL YEAR LENGTH )
,WIDTH BEDROOMS BATHS S 1`
ENVIRONMENTAL HEALTH:
SEWAGFJSEWER SOURCE: SEPTIC IUD SEWER❑ / NEW❑ EXISTING'
PLUMBING IN STRUCTURE? YES❑ NONt5 i Eyes,attach completed Water Adequacy Form
PERIIv1ETER/FOUNDATION DRAINS PROPOSED? YES 4. co.❑ EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revoation.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 torn at the necessary parties,Inducing arty 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 structures)for review and inspection.This permit/application becomes null&void 6 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
PE IT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
,,_, , 4 1 / 1
COUNTY CODE 14Ofl42)
Signature of OWNER(Must be signed by the OWNER) L Date I
:-DF,PARTIIEZiTALREVIEW=; ZAPPROVED":=L•DATE =_DENIED DATE`;".TAGS/NOTES/CONDITIONS_.
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH J 1 F'J1 -7-b -C 11 I IN'S C
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