HomeMy WebLinkAboutCOM2023-00054 - COM CD Environmental Health Review - 5/31/2023 0)1 'T2"'4:1gks. MASON COUNTY COMMUNITY SERVICES Permit No:�` O 'fl 2O2- -C )
4..,,,,,- C PERMIT ASSISTANCE CENTER: R ~ E I V E D
:a :L •BUILIJING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
.`— )I• p 615 W.Alder Street,Shelton,WA 98584
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.7,L,.+"—� i, Phone Shelton:(360)427-9670 ext 352-Fax:(360)427-7798 Phono
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ofrj, BclfI, (360)Z754467•Phone Elmo:(360)482-5269 J f 2023
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BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATI ' 'V Alder Street ,Z
ry
NAME: 1It FCO "'S1 t, C 9i/0 I NAME:
MAILING ADDRESS: WON N WW1 I01 MAILING ADDRESS:
CITY:S t'Nt-\t'e,n STATE:W I\ EX:18 5 ii LI CITY: STATE: ZIP:
PHONE#1:(S60)ell-Still PHONE: CELL: D 0
PHONE#2: Ems,:
EMAIL: ,nos re fr...so,.- to 1.or T Qrt REG# EXP. / / Li-
-
PRIMARY CONTACT: OWNER Y' CONTRACTOR❑ OTHER❑ = rn
' \ NAME S'''^t-S tits EMAIL J .w.sr0vnaSc,.-cud (,0r z
c MAILING ADDRESS ttc i i AI 1101 101 CITY S►u�hor STATE WA 2 W S Y H
— PHONE(-340)gl1- SZ tI N ,c,-LIS CELL csuq) 11e3 -gout
' PARCEL INFORMATION: r
PARCEL NUMBER(12DigitNumber) S.10 24 S'30)O 15' ZONING tC 'S
LEGAL DESCRIPTION(Abbreviated) A61r.\<.. fie...../AN (;.y\-.Vt.s (1t.k:)•IV FIRE DISTRICT -1 5 SITE ADDRESS ti/A CITY 5�.o I b e n —
DIRECTIONS TO SITE ADDRESS cror• curAl.! L{- A%A1+- (ict.&L i0r Aid 6 A wl-
c .t_Le-l-- 0a«f S-t oNJ Tr.p.-4-k, looh." IIar1.1, 6 4)ti‘+- Acwt• 'o
IS TICE PROTECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO RI SNOW LOA.D:16 psf
cf..
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checkoff thorcppfy);
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
`{ TYPE OF WORK: NEW❑ ADDITION ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Refdw,q Geroge;Commercial Bldg,Ete) V 4(r- S-0 r'k\L, .
Vej IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
�D HEATED STRUCTURE? YES(Whol&Bldg)❑ YES(Port(s]ofBldg)❑ NO V
L-) DESCRIBE WORK lr1 n .e Q13/4-Si la l r' •
- SQUARE FOOTAGE:(propate4
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 i-S 6 sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft.Attached 0 Detached❑
MANUFACTURED HOME INFORMATION: • *4 COPIES OF 1ilE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR. LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
• ENVIRONMENTAL HEALTH: -
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER❑ / NEW TING❑
PLUMBING IN STRUCTURE? YES❑ NO❑ yes,attach completed Water Adequacy Form
PERI ETER/FOUNDATIONDRAINSPRO YES❑ NOD EXISTING SQ.FT,
•
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER acknoo fP at submission of Inaccurate Inform atlon may result In a stop work order or permit revocation.Acknowledgement of such is by
signature bele .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 al the necessary parties,Including any eascrrient holder or parties of Intrust 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 structures)for review and Inspection.This pennitlappflcalion becomes null&void it work or authorized constructor'Is not commenced wsthln 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)
x ,ainw 4 "LI- 20z3
ignature of OWNS Must be signed by the OWNER) Date
:RE FARTKENTALUVIEW -s;4'AP2RQV.D!: 'DAT „-1", wNIE11,;-'D4.TE,:'TAGS/(•TOTES/CONDITTO S_
BUILDING DEPARTMENT .
•
PLANNING DEPARTMENT
FIRE MARSHAL �M� ��
PUBLIC HEALTH �$ 1f� GM" i.V C( c:\.
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