HomeMy WebLinkAboutBLD2023-00517 - BLD CD Environmental Health Review - 5/15/2023 N ` MASON COUNTY COMMUNITY SERVICES 1 /. i
4' - t PERMIT ASSISTANCE CENTER: Permit No: 2.2I(1° G '(;�,`�)
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL` RECEIVED
615 W.Alder Street Shelton,WA 98584
""PA..---- Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
Belfaic(360)275-4467•Phone Elma:(360)482-5269
"" MAY 10 2023
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTORINFORMATIP:5 W. Alder Street
NAME:ge(j4 v 1-4c`IYWS t. . . NAME: C-Y-c,- f+DrY..0.s L(,C.,
MAILING ADDRESS:05V i12*s} C S . C MAILING ADDRESS:
CITY:"Ti a.v^c. STATE:W Pc ZIP:qi 4`-6 CITY: STATE: ZIP: rn
PHONE#1: PHONE: CELL: z
PHONE#2: EMAIL: g r.t.1 Az r1 cp IA io Pq C,C...... C
EMAIL: PrcCiik, 4-th�@✓r 6cgc.cv.-.. L&I REG# EXP._/_/_
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER�Il` Z
NAME Vcu. cA.s. eoci EMAIL \k4 Gib@ rc^1'd SEr1�Cer.Cot''. rn 0
MAILING ADDRESS CITY STATE ZIP > Z
PHONE 2S3- l0'5I-t-lhg9 CELL
PARCEL INFORMATION: PT•I
PARCEL NUMBER(12 Digit Number) Z 2 12-'1 -1 I- 9 01 4-4 ( ZONING la
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS SC GA-c c+ CUvt, LIB _CITY -_ a >
.
DIRECTIONS TO SITE ADDRESS Lin 2 r
1 .=:._ O
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO w
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): /
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEWS ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Etc.) £Cl Y A e,( I Cot- PO r t
IS USE: PRIMAR) SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Perils]of Bldg)❑ NO
DESCRIBE WORK Cam.1 P c >rz-f
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 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: SEPTINL SEWER❑ / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES❑ NO‘ If yes,attach completed WaterAdequocy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 0 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 permitlapplication becomes null 8 void if work or authorized construction is not commenced within 180
days or if construction work is suspended fora 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
(---_p COUNTY CODE 14.08.42)
X `.i 1D -123
Signature of OWNER(Must be signed bvthe OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL ' `� ' I
PUBLIC HEALTH lZk‘r 6(i fv (/`�`i I ' 4,
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