HomeMy WebLinkAboutBLD2023-00408 - BLD CD Environmental Health Review - 4/20/2023 >, ,sis'''''''44 MASON COUNTY COMMUNITY SERVICES Permit No: 45LQ202 - oo (/o
rI• PERMIT ASSISTANCE CENTER:
A •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL r"."•r'#.--.q—!1`g I I r
'I - 615 W.Alder Street,Shelton,WA 98584 1 ',.' 'Li I—.Y V it.—i.,I
,.,. Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
2t `'^:v Be/fair(360)275-4467•Phone Elmo:(360)482-5269 ; 7 2023
BUILDING PERMIT APPLICATION 0 N M ENTAL
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: v HEALTH
NAME: 4 }-< C v/ �(t,VAS`- _ NAME: C(CarM LACo",(.1 Coy.,
MAILING ADDRESS':.'Cy 4 mei kin- MAILING ADDRESS:Q0 Zpc 1,,Cp
CITY:j Ip 1)7yf i 4, STATE:i.-&, ZIP: ' CITY:Le,e,e STATE:t�A- ZIP:ez S?SGcj
PHONE#1;,5 t13 7 C '76, •S.S PHONE:?,it,oLTy 7..9jI10ELL: —
PHONE#2: EMAIL: `FYGnt/,L7.+nf1 C05yrfA.Y.tOr^'+
EMAIL:! K c y Dr,o✓c: CO- t',r t Cv P'rNI A'I REG# Vr,,nY-,,C't 13N,; EXP. Cg./;p/Z,3
PRIMARY CONTACT: OWNER❑ CONTRACTOR it'......--
OTHER❑
NAME.aay.> 2 4 1 t EMAIL
MAILING ADDRESS v (�2.f,1 't' tD7' S fCO CITY Lc,c----'-T STATE WA` ZIP ac. o'7
PHONE 3l120-742-'4t{3`-( CELL AN/
PARCEL INFORMATION: Lbw
PARCEL NUMBER(12 Digit Number)3W 5-4- 1 -D00 I O ZONING APR 2 0 2023
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT RECEIVED
SITE ADDRESS I'ZZ LceS�vi Lt.J 9 a., CITY Sb..�\-o.n
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO Ile<OW LOAD: psf
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,Erc)Aj eG) M I-j
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg) YES(Pari[s]of Bldg)❑ NO❑
DESCRIBE WORK IJ.6,0 Ai
SQUARE FOOTAGE: (proposed)
1ST FLOOR 1%I.r}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.ft. Attached❑ Detached❑ CARPORT sq.ft Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF TEE FLOOR PLAN REQUIRED*
MAKE Dreo.* 54, `f e'S moDELDSZW14 tf YEAR ZjZ'$ LENGTH 4.1
WIDTH Z 7 BEDROOMS 3 BATHS 2_ 1 3 SERIAL NUMBER D
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC[[}SEWER❑ / NEW[ "----- EXISTING❑
PLUMBING IN STRUCTURE? YES L./• NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO/fr---- EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
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 8 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
_ COUNTY CODE 14.08.42) 1
/Signat*of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL PUBLIC HEALTH a' `f�l11, GC
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