HomeMy WebLinkAboutBLD2022-01537 - BLD CD Environmental Health Review - 12/13/2022 . � ��2o2l- Oi 31
s 4 MASON COUNTY COMMUNITY SERVICES Permit No:
< �� �t PERMIT ASSISTANCE CENTER:
.BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL �\
14` I I• P I 615 W.Alder Street,Shelton,WA 98584 /
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Y,f Phone Shelton:360)2 5-4(360)427-9670 oxl. -Fax:360)4(360)427-7798 98 Phone \
1i� �� Bel(air.(360)275-4467 Phone• Elma:(360)482-5269 1\`•U,
BUILDING PERMIT APPLICATION ; ;
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: �/ r•2 ~'�
NAME: 711 KA Rol S:AAA NAME: 7-,
MAILING ADDRESS: 2,1.2. 44314w S4-.0e.y N2• MAILING ADDRESS: 4..,)
CITY:(All hi•ft I a c e STATE:WA-r ZiP:9c`t ,7 CITY: STATE: ZIP: ( , ,
PHONE#1: 5-3 '2;4 - S(e '5 K PHONE: CELL: ijF•_
PHONE#2: EMAIL: -'/
EMAIL: L&I REG# EXP._/ /_
PRIMARY CONTACT• OWNER pc CONTRACTOR❑ OTHER 0
NAME 5 e-J- [tbc ye. EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL E.n Y 1V/ /t
PARCEL INFORMATION: 1�OI ., � 7C
�PARCEL NUMBER(12 Digit Number) '2 2 S C) 2Z i ZONING kiEti i r. Tq
LEGAL DESCRIPTION(Abbreviated)•I iyh19�'✓•1t�FC *I LC'T: 2 O FIRE DISTRICT j 441
SITE ADDRESS 1 i E Re:CC&c.,, CA- CITY She-1+0'1
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO 15, SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW/if ADDITION❑ ALTEERATION 0 REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) ge-5 aQ y e-e,'
IS USE: PRIMARY 12i SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2.
HEATED STRUCTURE? YES(Whole Bldg)
JJig: YES(Part[s]ofBldg)0 NO❑
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DESCRIBE WORK New IMcik, c,i'ft•4^e-47 {-} e
SOUARE FOOTAGE:(proposed)
1ST FLOOR I Zft(p 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.R Attached❑ Detached 0 CARPORT sq.ft. Attached 0 Detached❑
MANUFACTURED HOME INFORMATION:N *4 COPIES OF THE FLOOR PLAN REQUIRED*
p
MAKE I"l/It�L0 MODEL �D t/2' YEAR /0 22 LENGTH 443
WIDTH 2.7 BEDROOMS 3 BATHS 2.. SERIAL NUMBER �
ENVIRONMENTAL HEALTH: SW t /92022" O�v
SEWAGE/SEWER SOURCE; SEPTIC a SEWER 0 / NEW lig EXISTING❑
PLUMBING IN STRUCTURE? YES rir NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT. 1 2-9 t'
EXISTING BEDROOMS PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
0 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 APPLICA ON OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
W\ .. /^y COUNTY CODE 14.08.42)
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i2 5 _ -2--2._
'signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL r ,,
PUBLIC HEALTH K�� 5icbf Z3 �N`LA 111Z/jvS adC1
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