HomeMy WebLinkAboutCOM2023-00060 - COM CD Environmental Health Review - 6/8/2023 r.
o��.r'tx-''14�. MASON COUNTY COMMUNITY SERVICES PermitNo:wl� Z� �O
' PERMIT ASSISTANCE CENTER:
"I •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
:rl I• 615 W.Alder Street,Shelton,WA 98564
T. I I' f
y�/. Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
�r" A/ Bellair(360)275-4467•Phone Elam(360)482-5269
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Washington State Parks NAME:Active Construction,Inc.
MAILING ADDRESS:PO Box 42650 1111 Israel Road SW MAILING ADDRESS:Po Box 430
CITY:Olympia STATE:WA ZIP:98504 CITY:Puyallup STATE:WA ZIP:98371
PHONE#1:360-725-9757 PHONE:253-248-1091 CELL: 253'905-107
PHONE#2: EMAIL:Chases@ac6veconstruction.com
EMAIL:sanh.to@parks.wa.gov 1,&I REG#ACTIVCI164JL EXP.11 /7 /23
--- - m
PRIMARY CONTACT: OWNER 0 CONTRACTOR Q OTHER❑ Z
NAME Act"con.”""°°".Inc EMAIL cttases@activeconattucttort:corn
MAILING ADDRESS PO Box 430 CITY Pvr'u p STATE W ZIP9B3'% /
PHONE 253'j4s1091 CELL assadstonDO
PARCEL INFORMATION: JUN 0 pv 2023 Q
PARCEL NUMBER(12 Digit Number) 619322060000 ZONING RE^.... Z
LEGAL DESCRIPTION(Abbreviated) N1I2 NE NW NLY OF CO RD EX PT TR 1 FIRE DISTRICT L'LlVe
SITE ADDRESS1365 W Schafer Park Rd.Elmo,WA 98541 CITY = m
DIRECTIONS TO SITE ADDRESS From West HWY 12 take a right on 4th street.Cnce on 4th,take a left on Old HWY 410.Once on Old
HWY 410 continue for 112 mile,then take right on E Satsop Rd.Follow E Seise()Road for 12 miles and project is on the right. Z
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO 0SNOW LOAD:_psf D
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): - r
SALTWATER❑ LAKE 0 RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION 0 REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Pie.)Water Silo
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS° NUMBER OF BATHROOMS°
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Port[s]n(Bldg)❑ NO Q
DESCRIBE WORICConstructing a water silo to hold water from existing ensile well.
SQUARE FOOTAGE:(proposed)
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. OTHER315 sq.ft.
GARAGE sq.ft. Attached 0 Detached 0 CARPORT sq.ft. Attached❑ Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
1
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER 0 / EXISTING 0
PLUMBING IN STRUCTURE? YES❑ N If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAIN SED? YES 0 NOD EXISTING SQ.FT.
EXISTING PROPOSED BEDROOMS 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 ant 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 teal the information provided is accurate and grants employees of Mason County access to the above descrioed property
and structure(s)for review and inspection. This permlUappdication 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 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 5' 74 05/08/2023
Signature of OWNER(Must be stand by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL ,,, ��Q�
PUBLIC HEALTH 1i'bf^i/3 (_( ,` 't/�'Ir „�""�11
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