HomeMy WebLinkAboutBLD2023-00454 - BLD CD Environmental Health Review - 4/28/2023 a�QwP'1144*, MASON COUNTY COMMUNITY SERVICES Permit No: I r d2Ei 1 '3
PERMIT ASSISTANCE CENTER:
..`i, •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
• t; , T 615 W.Alder Street,Shelton,WA98584 APR 25 2023
y^.... -rwh P. Phone Shelton'(360)427-9670 ext.352•Fax (360)427-7798 Phone
.%. ,w Bel/air(360)275-4467•Phone Elma:(360)482-5269
1°'.Hfn3 - 615 W. Al(1 +- Street
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION:: CONTRACTOR INFORMATION:
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NAME:A-lt}(t'(4N 1 G�' J NAME: 14 ,(`r fu b A S I—LR N�
MAILING ADDRESS: O �X I] MAILING ADDRESS: 7'
CITY: STATE: w ZIP:Cj 4 CITY: STATE: ZIP:
PHONE#1: - 61- 1O2( PHONE: CELL: 0 -
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PHONE#2: — — EMAIL:
EMAIL:/>Iyt,pvY}0(hOt•f('.R CD•COir L&I REG# EXP. / / _ G I--)
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PRIMARY CONTACT:�+ /� OWNER 18 CONTRACTOR❑ B�,,O.,TIHER❑ ^ ( �� 0 `
NAME �U G.4euq J EMAILVVICri W10c 1Vee/W lM'1 C�,fM = DO
MAILING ADDRESS 1�OX 2C CITY STATE JA- ZII�7S7 4 PP
PHONE' Qtj ' CELL 2O — SO—iO2t t,. Z
PARCEL INFORMATION: Eli-
PARCEL NUMBER(12 Digit Number) 2 62-I _6e 044 O IA'3 ZONING = r fl
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT Z
SITE ADDRESS CITY S+ tXO 1J —I
DIRECTIONS TO SITE ADDRESS • tU 0D
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO 0 SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW g. ADDITION 0 ALTERATION❑ REPAIR� r 0 OTHER 0
USE OF STRUCTURE(Residence.Garage.Commercial Bldg,Etc.) 'JDJ C6 yy G A t QE e�
IS USE: PRIMARY K� SEASONAL 0 NUMBER OF BEDROOMS e2_ NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(WhooleeBldg)' YES(Part's)of Bldg)❑ NO 0
DESCRIBE WORK COOSiRUl/t IDI, of t i j s w-Giti Ff}'Imi LY A-tQUS6— 1 STOW(
SOUARE FOOTAGE: (proposed)
1ST FLOORttOOIO sq.ft. 2ND FLOOR WA sq.ft. 3RD FLOOR IVA- sq.ft. BASEMENT N/ sq.ft.
DECK il75 sq.ft. COVERED DECK / sq.ft. STORAGE_WA sq.ft. OTHER k/A- sq.ft.
GARAGE 44Q sq.ft. Attached N( Detached❑ CARPORT W./A sq.ft. Attached 0 Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE JV A MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: ` 61yi Yl c
SEWAGE/SEWER SOURCE: SEPTIC X .SEWER 0 / NEW❑ EXISTING,
PLUMBING IN STRUCTURE? YES le NO D If yes,attach completed Water Adequacy Form'
PERIMETER/FOUNDATION DRAINS PROPOSED? YES NOD EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 2. TOTAL BEDROOMS 2
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 permiUapplication 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
14.08.42)2j , .COUNTYCODE
25. 23
Signature of OWNER( t be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL {��
PUBLIC HEALTH l'f z3 Cc��d,.(VeA.s
4 64' �. EH Setbacks
A.) Drainfield/Reserve requires 10'setback from footing/toundations
A ♦ B.)Septic tank(s)requires 5'setback from all tooling/foundations
C.)No foundation/Perimeter Drains within 30ft,downgradient of
EH APPROVED Drainfield/Reserve area
N D.)No Cut Bank(s)(greater than Rand over 45 degrees)within
% Rhonda Thompson 05/09/2023 505,down gradient of Oraintield/Reserve area
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14 6" ► W
4 i 10' 4 40' 0" E
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1) HOUSE I Co L cz
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5; 4 14' ► rn \ p
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AND 1 1 N � O � O +�
METER EXISTING 15 in 1 N U
N •(EXISTING) .. _ �� t I a. N `\Ts u) .a)
r. " -+ \` 1 2 = O
•• ♦ .......` 1 LL (n «- Q«n
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DRAIN FIELD ` ••\ _ I c
(EXISTING) \\ 0 Q. -,
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11
.-. .• .... •• — .. a •. •• • • 11 >4 I ^ N y
L -------- 1 iQi\ E c n
11 I Q SR N
11 I O c� R
Q I Z o L
RESERVE DRAIN FIELD 11 1 I J U _U
(EXISTING) i i a c a
11 M
IY
70. E. Kingston Way
• t�3(ci 2023 .40i-15`-
SITE PLAN Scale: 1" = 20'
Owner: Alexandra Garland, Emilia Piechura Site Address:
Address: PO Box 2088,Shelton, WA 98584 70 E. Kingston Way
Phone:206-459-1021 Shelton, WA 98584
Dwn by: Alexandra Garland Signature: ,� '
Date: C���'