HomeMy WebLinkAboutBLD2023-00210 - BLD CD Environmental Health Review - 4/18/2023 ,`.G rLw%I. MASON COUNTY COMMUNITY SERVICES Permit No: r2()023"'b0 GL 10
A PERMIT ASSISTANCE CENTER: (" ��11-!'1
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1•BUILDING•PLANNING.PUBLIC HEALTH•FIRE MARSH ALI •„r E
5 •I I• I 615 W.Alder Street.Shelton,WA 98584
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�y f .�* / Phone Shelton:(360)427-9670 ext.352•Fax:(360)427.7798 Phone�^ES 'Yl "r
� ' -^`yam Belfair:(360)275-4467•Phone Elma:(360)482-5269 �U�`'l E t'V 1 R 0 N M E N Tq L
BUILDING PERMIT APPtBdATLQKOd.er Street HE a L j H
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Dave 6 Anne Peersen 17Inlets LLC NAME:ANDIZF-1 J S3E AIZ
MAILING ADDRESS:8605Da°soncif MAILING ADDRESS:
CITY:' ° STATE:Tx ZIP:'S°25 CITY: STATE: ZIP:
PHONE#1: PHONE: CELL: 3Lt -g19D O 'Z4
PHONE#2: EMAIL:_SFEATZ .00NSIZd.2C7IOnla CA AIL I CO
EMAIL:de°"2'".eveaenhaelgreup.eere , L&l REG# EXP._/_/ _
PRIMARY CONTACT: OWNER D CONTRACTOR❑ OTHERS,
NAME 'ire''""'"'" EMAIL s"d•w44.nwrw6weang.oew
MAILING ADDRESS 2113'dA" CITY$ea'ea STATE WA ZIP98121 173
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PHONE �6169 CELL Uuu
PARCEL INFORMATION: < co
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PARCEL NUMBER(12 Digit Number) 12031-12.90030 ZONING RRt 0
LEGAL DESCRIPTION(Abbreviated) TRACT BOFSP110.AFN39856eGOV el.31•20-01W FIRE DISTRICT 5
SITE ADDRESS 821E Camden way CITY Shenon WA 98584
DIRECTIONS TO SITE ADDRESS From E South Siend Dr,nghl el E Ho.tine Island S.'deow egne Wm pent expnatan Peel Way)en lee 37_i'Hi1B16 Austin-names on tree ��.e
Follow rindennere e�gns to and o1 road and there s a link A-frame c[�?g no-DE, - 4 tem ?ZES• I 1 C p ` J N
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESD NO 0 SNOW LOAD:3'psf
IS PROPERTY WITHLN 200 FT OF THE FOLLOWING: (Check all rhos apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION❑ REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage Commercial Bldg.Erc.)RGvdence end Detad'e0 Ge
roge A LON U tJ/ ZEMOVA L og 2 j g 3 6 Q•FI•
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS\3 NUMBER OF BATHROOMS 3 to. F X ITIN 61
HEATED STRUCTURE? YES(Whale Bldg)0 YES(Part IS]of.Bldg)0 NO 0 V• 1 V A J A' .
DESCRIBE WORK new a"gle family residence min detached garage •
SQUARE FOOTAGE: (proposed)
1ST FLOOR i906 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT 138' sq.ft.
DECK 579 _sq.ft. COVERED DECK 511 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached 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 0 SEWER 0 / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO❑ If nee,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT. Sit
EXISTING BEDROOMS ° PROPOSED BEDROOMS\S TOTAL BEDROOMS F S
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 pernission 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 descrbed 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 CONTINUA •N OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATIO eF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
x r i C2/23/2023
Signature of OWNE• ii st be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL '�/��y�,,,,�� ,,Q ,,
PUBLIC HEALTH (Jf_,S VI ) 5 Ct- -Q�
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m S"s PETERSON RESIDENCE 821 E CAMDEN WA �8�I;j.+!C� .,, _A <
v §N§#a SHELTON,WA 98584 i I
D ¢ PROJECT#:21-PETE-153 ,tI,L.�'g• r- le x b
1 t 1 4 PHASE 2.0-PERMIT SET
TAX PARCEL#:12031-12-90030 {0� In•`i , ���
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