HomeMy WebLinkAboutBLD2023-00299 - BLD CD Environmental Health Review s` c''Yeth i MASON COUNTY COMMUNITY SERVICES- �-P�R► —cop 9�J
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PERMIT ASSISTANCE CENTER: IN C Cie
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@" 615'Al.Alder Street,Shelton,WA 98584 5 2023
?�--"-� l%``7 Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone MAR 1
��e+'' ` ti' Be/fair(360)275-4467•Phone Elma:(360)482-5269
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1°' w "� Alder �g
BUILDING PERMIT APPLIQA' 1a�' `1 `� �/IRONi MENTAL
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: HEALTH
NAME: AA R.0 N A RAC NAME: AA K0..1 Pia-Au
MAILING ADDRESS: I L%o E. b12�WOOD)Alf MAILING ADDRESS:I L3D • a.eJ trx.1'2 PJQ.
CITYc'O`EEI.flt.) STATE. 3._ ZIP:1-143( CITY:Poi, Q�'-per STATE: (A ZIP: Lea
PHONE#1: 3 c1 a- 5(Q7 PHONE: CE L:
PHONE#2: EMAIL: aRArIISD4{� .0 ) t j(.ic - IY\ CEMAIL:A•SCAIA_ AA4LCl t`I Q ii(pthi , Ors\ L&I REG# EXP.//n1I
PRIMARY CONTACT: OWNER XCONTRACTOR❑ OTHER❑ 1 1 Li' Ill,5- '7 8 c ..V...5\
NAME �ArCd)tJ AI}.k. EMAIL �A MAILING ADDRESS 12 i. C' 0 ',NJWOOI. , A CITY T✓ilFcx11N STATE CA ZIP 9 k PHONE 3Qa , \ 5(,•) CELL j�Q Lij 46 PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 3 a..l c2,7 5 I co i ci ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 3 '( (. SAtil1< At...loci-WS j1a CITY `✓ife.t.ro,tJ
DIRECTIONS TO SITE ADDRESS HVEgt,, Eir5r o'- /7145on) I-A icof lew> 7v,? /
rm s,"OCR-•r, cvv 6.--.54fi0r/Aivole* 5- 77,. 7;QDPE,e77 /, ,3 M l c�,5 e/d (4)1—Pr'
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):NO
SALTWATER 0 LAKE❑ RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW[g ADDITION❑ ALTERATION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage.Commercial Bldg,Etc.) 1(✓j I t I''v11(
IS USE: PRIMARY54 SEASONAL 0 NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS a
HEATED STRUCTURE? YES(Whole Bldg)X YES(Pants)of Bldg)0 NO 0
DESCRIBE WORK \I C atJ'5e t) 'C c : I7 S •c � {A i4 ' .
SOUARE FOOTAGE: (proposed)
1ST FLOOR/O D sq.ft. 2ND FLOOR_6("kg.ft. 3RD FLOOR /YA sq.ft. BASEMENT /SA• sq.ft.
DECK _sq.ft. COVERED DECK3(00 sq.ft. STORAGE N/A - sq.ft. OTHER N/A sq.ft.
GARAGE_ _sq.ft. Attached 0 Detached CARPORT /.I/Q sq.ft. Attached 0 Detached❑
MANUFACTURED HOME INFORMATION: ,i i/ *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL /Y YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC k' SEWER 0 / NEWT EXISTING 0
PLUMBING IN STRUCTURE? YES NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES® 3 NOD EXISTING SQ.FT. �'
EXISTING BEDROOMS PROPOSED BEDROOMSTOTAL 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)
X
Sigaa `re of OWNER14ust be ed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL PUBLIC HEALTH iz (o[ri J 3 C,,,,s"7 M S 4 ?
a l-'DoaDg�- c 0 a9
RR5 Zoning
Front Yard Setback. 25'.
Side & Rear Yard Setbacks. Residential dwelling
and accessory structures is 20'.
OR 10%width of lot if not more than 100' wide
OR approved ADV
N Semaols are 1,1e86Ue0 hom trw L•Neil
argeCen CI the 801b1,0
10'Min.-ADV2023 00041 _ / 5'Min.-ADV2023-00041
Jas measured from tthe?weer,tu .?weer,PeIKb^ theWekp
N
./� // N aWMs EHAPPROVED
/
Rhonda Thompson 06/12/2023
1N042 w .em0 aoea
wee♦eae Y61� / �a MRef<
\ - \�e.e.m.6arr*n/
/NEW \ N.
SIDENCE /
LW wee eer me Nemaw ee. \\ ` /
/
N / / �#/-
N.- � /Q
NT
ia,,'0 \ \ \.i ,'
�- .� ..its _ i
01 01 a a .0 6... iew"�"Y�wa //I
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5'Min.-ADV2023-00041 / //All setbacks are measured from the furthest / ///
\ /projection of the building. (((
EH Setbacks PARCEL NO, 32121-5,-00W
A.) Drainfield/Reserve requires 10'setback from footing/foundations LEGAL DESCRIPT,CN• LAKE LSI!RICK 2 TR.M!!
B.)Septic tank(s)requires 5'setback from all footing/foundations SIFE mDQESS, !el E ST ANDRE%DR
C.)No foundation/Perimeter Drains within 30It,downgradient of SwELTONI,L1i96•INGTON SESEA
Drainfield/Reserve area
D.)No Cut Bank(s)(greater than 5f1 and over 45 degrees)within
500,down gradient of Drainfield/Reserve area .
SITE PLAN
SCALE,••20'.O•
NORTH
05/19/2023
APPROVED
MASON COUNTY DCD PLANNING
seam RUEDY,AIQP
Digitally
soon Ruddy signed
by Scott
Ruedy