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HomeMy WebLinkAboutBLD2023-00067 - BLD CD Environmental Health Review - 1/19/2023 I <^ `' '7,,,,. MASON COUNTY COMMUNITY SERVICES Permit No: bIaWZ3 ���/�� PERMIT ASSISTANCE CENTER: 'r .BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL I! 615 W.Alder Street,Shelton,WA 98584 l- Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone Belfair(360)275-4467•Phone Elma:(360)482-5269 E BUILDING PERMIT APPLICATION E�V PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: Ar 1 NAME: t -vvvev‘ OVVCkevt,00 )G� NAME: 6 �I� 2023 yt MAILING ADDRESS: 53-o►$ P Na(,_ac> g..t,4 MAILING ADDRESS: /�� CITY: 4�uv i a STATE: 44 1 ZIP:9 toi I"1 CITY: STATE: ZIP: der S tr PHONE#1: !1C 8 2 S3 9 g 4.(P PHONE: CELL: e e l PHONE#2: (i ¢30 (30 4-2 EMAIL: EMAIL: (y v'rre,h aurae vuc!d (rat.at. i G4&I REG# EXP._/ / PRIMARY CONTACT: OWNER II CONTRACTOR❑ OTHER❑ NAME La.,rY'.' C)1.11 l e J C elelEMAIL I d ✓e- i (1l-,.'/E'n-t,onod c)q*t(•Cwtt2r TA MAILING ADDRESS 53-0 18 ilk tom.k.,0 IQ CITY 4.4(..10 La STATE Ff ( ZIP qr.)qr.) 711 PHONE �.0 EL, 2-53 'I�4-Cf CELL PARCEL INFORMATION: F i . ENVII�Q +1 PARCEL NUMBER(12 Digit Number) 1-2((`1 - is'.- 50 i 0 ZONING �j y1 E N L LEGAL DESCRIPTION(Abbreviated) J ,x-e•i f+ S 13 IT IJ Q-1 A) FIRE DISTRICT SITE ADDRESS a(o I S ri`S�f )2_ 4,-, 12�( CITY (In<�n_ HEALTHDIRECTIONS TO SITE ADDRESS f IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO H SNOW LOAD: ps( IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER❑ LAKE❑ RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEW ID ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0 USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) ,c1.1(,1 .C. IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF EDROS NUMBER OF BATHROOMS HEATED STRUCTURE? YES(Whole Bldg)0 YES(Part(s)ofBldg)0 NO 0 DESCRIBE WORK SQUARE FOOTAGE: (proposed) 1ST FLOOR _sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BAS. ...ENT sq.ft. DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. O5T„HOR 33(Osq.ft. GARAGE. 7Ptt-sq.ft. Attached❑ Detached 0 CARPORT sq.ft. Attached 0 Detached 0 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] SEWER 0 / NEW lia. EXISTING 0 PLUMBING IN STRUCTURE? YES p NO❑ If yes,attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES 5.. NOD EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS CJ TOTAL BEDROOMS 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 160 days or if construction work is suspended for a period of 180 days. PROOF C IN ATION OF WO ON HIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS P IT ' LIGATION OF 180 D S MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY CODE 14.08.42) X ( 0 1 -07 ` Z `3 S lure of OWNER( st be i d e OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL r ',� ,,f CC�9\ PUBLIC HEALTH ' k 6; 1 - I�5 G�`'� th S �-- 1 o S \•I . r v .., i m Cl \ m _ \\ 1 L1 ' \ i I'�� o�n `` v —_. D 1 p m I I 1 .'E 'III I 2 w _ 1 ti 76' 1 .1 I as ,k t - j wi.. F 1 0 m 3 I 1 am • NI II N w L 1 i l N 1 1 1 1 1 11 D O O n©D . z5zvro 11 1 0° m°a m 1 1 UV 1 7 c 9, 0 1-litil t1=L $ = Rsl %' oww3m m ,.1 I. 5'zi m uic = 1 I o.d Om m (n i 1 4D ymo 1 1 z a so a 1 iI y° 5 3 9 kw O i 11 y v s..o X 1 W Oa oo 3 W m f 5 o' wNr ; °o5 OZMM-I>Om-00 \ 1 o m °c 9 0 0 D A A S Z A O 1 1 w 4° g v-iic�imm>z� � 1 . m A N m ! g d 1 >0to G)o> I - o0. mX,r-DmO00m- \`\ 1 ° % o QmtnZmm rn�0 \\ 1 m' °°NAOmynm0 •.\ I A<ii?Q-u 0• �1m�1 `\ I D0mvi�zcO0 \; 1 CI Ot mm>> \ I D m N O r Z A>0 \ 1 x _O 0 D my n mmp.<Z \ 1 Norm OjDOO \\\ I mm 00 Dar \I COigaO O mm m- coG mnm� H D o V i-4 -IW -lot = ooN 0 r S= 0 OZZ m=w 14 g c Z • TIC Z.4 >. G) x�3 j Z�� rn C N D ��_ Co• A =1 oc c C N15 A r AZ 0 0 - cwi a. woc o� m m O< 0 rn 0 a IND c W o m' o a 3 0 a VI _.I r; v I o.wlrets..onno), —._ m w _menucl,.-.-r_ N ; .. w I w+rE e MOO W PLOT PLAN urulawood -_ _� N W ,bONI.,Eq I