HomeMy WebLinkAboutBLD2023-00203 - BLD CD Environmental Health Review - 2/21/2023 �rsos coo4,� MASON COUNTY COMMUNITY SERVICES
►', e PERMIT ASSISTANCE CENTER:
M Permit No: I�jlCi2o2 -Q3ZO�j
•BUILDING••PLANNING ••PUBLIC HEALTH••FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584 RECEIVE D
` Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
Belfair.(360)275 4467•Phone Elma:(360)482-5269 �I FEB 21 2023
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BUILDING PERMIT APPLICATION 615 W. Alder Sget
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: =
NAME: fi r:,\ , 'c \tccrS°`n NAME: D 0
MAILING ADDRESS: V V C N K.X. \ MAILING ADDRESS:
CITY: e\QcsaN'-. STATE: Wt.. ZIP: q4 51-. CITY: STATE: ZIP—I
i PHONE#1: '3\O "1 % (CC.Gl PHONE: CELL: = Fri
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PHONE#2: EMAIL : _•,I
EMAIL: &1/4..S• k C 1 ( WAc \ L&I REG# EXP. /_
1 PRIMARY CONTACT: OWNER pff CONTRACTOR❑ OTHER❑
NAME ��C•-v- \ >`C7('A � EMAIL 6- S a\..S\���C�:\-�� C�A'N` \
MAILING ADDRESS \—1 43' jv G met 0 CITY . \ ' -• STATE vUA ZIP G c 2. :
PHONE WO -i 0 - CXC'�C.. CELL
c.c `;.; - 7/G j
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) \` g-N 61 54I%MIt C LAZO VtiVt•Sz,v1
LEGAL DESCRIPTION(Abbreviated) T( C cR c� \j to1,, t`-Ack `4T '1 F IS•
SITE ADDRESS \-1O k.,1 k\•ee: '\.w, 4-c CITY ti \x-
DIRECTIONS TO SITE ADDRESS 'F,c-C,,--, c.0.a4.6 .\\ •}Q,i-r• . O be\kc\Nkr (" -li‘cr
9tkkN czv\ \L.k \-c.\\ 'L." \Cr �,,.‘ t-' V,''c
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO iiir
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 ❑ ALTERATION ❑ REPAIR ❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) C"t,(-V'e 1 SY\e..,
IS USE: PRIMARY ❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg) ❑ YES (Part[s]of Bldg) ❑ NO K.
DESCRIBE WORK 3T GU' K \ C. 0\e__, " KNNI
SQUARE FOOTAGE: (propose+existing)
1ST FLOOR 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 ra.CS sq.ft. Attached❑ Detached ` CARPORT sq. ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL EAR LENGTH
W TH BEDRO BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC A SEWER❑ / NEW ❑ EXISTING
PLUMBING IN STRUCTURE? YES ❑ NO(i( If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NCI 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 y easement holder or rties of interest regarding this project. The own ry r�le�el
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EH SETBACKS -
-
AI 0ra.nfie!d/Reserve reboots 10 setback from foottng/loundatans
Br Septic tank(s)requires 5'setback Iron all Poor ng/loundauons
CI No loundarion/perimeter drains within 30'down'gradren(of drarnhe''1,' _?
reserve area d
0)No curls),bank(s)(greater than 5'er over 45 degrees)within 50' -
down-gradient of drainfeld/reserve area
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EH APPROVED ` `
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TOPOGRAPHY PROFILE: S`Uq---S V ywc.,:c-e 51 Y'k uC go\
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2U23 aj2U3 I Direction: kcal@- Approval: for office use
Building Permit number: ; Building:
Owner/Applicant: �Gu�,), gealiN`NSCH1 Date of
Planning:
2 1 -i r L� application: Env. Health:
Parcel Number: 12 SV —1 C/06 b J
RECEIVED
Rot ?10,
scn\e �„ FEB 21 2023
615 W. Alder Street
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APR 1 7 2000
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Frnted From Mason County DMS
Printed from Mason County DMS