HomeMy WebLinkAboutBLD2023-00359 - BLD CD Environmental Health Review - 4/4/2023 t Q�,0,114`''r'`aki,, MASON COUNTY COMMUNITY SERVICES Permit No: 3' �
• PERMIT ASSISTANCE CENTER:
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%y' ; Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone AiR - is 2023
`r�. ,;. Belfair.(360)275-4467•Phone Elma:(360)482-5269 -17
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•F�t.,�.,t� BUILDING PERMIT APPLICATIbNW Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION• EAL
NAME:Ryan&Jessica Smith NAME:
MAILING ADDRESS:591 SE Ellis Road MAILING ADDRESS:
CITY:Shelton STATE:WA ZIP:98584 CITY: STATE: ZIP:
PHONE#1:360-490-3040 PHONE: QELL:
PHONE#2: EMAIL :
EMAIL:rsmith0384@gmail.com '4 L&I REG# EXP. / /
PRIMARY CONTACT: OWNER 9 CONTRACTOR❑ OTHER❑ •
NAME Ryan Smith EMAIL rsmith0384@gmail.com
MAILING ADDRESS 591 SE Ellis Road CITY Shelton STATE WA ZIP 98584 ,
PHONE 360.490-3040 CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 31903-21-00020 ZONING RR2.5
LEGAL DESCRIPTION(Abbreviated) NE NW EX S 175'OF E 500'S39/118 FIRE DISTRICT Dist 4
SITE ADDRESS 591 SE Ellis Road CITY Shelton
DIRECTIONS TO SITE ADDRESS Take SE Olympic Hwy.to Cole Road-Follow Cole Rd.past Fawn Lake-Take SE Ellis Road on the Left-Follow
SE Ellis Rd.,591 will be on the left
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO B SNOW LOAD:25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION D ALTERATION 0 REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)Residence
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2.5
HEATED STRUCTURE? YES(Whole Bldg) 0 YES(Part[s]of Bldg) ❑ NO 0
DESCRIBE WORK Adding a new kitchen on to the side of the exisiting residence
•
SOUARE FOOTAGE: (proposed) ,
1ST FLOOR 316 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT _ sq.ft.
DECK_ sq. ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq. ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ 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 0 / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO ❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION D S PROPOSED? YESA NOD 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 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 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)
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ign o OWNER(Must be sianed by the OWNER) Date
DEP THE TAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
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PLANNING DEPARTMENT
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