HomeMy WebLinkAboutBLD2023-00603 - BLD CD Environmental Health Review - 5/30/2023 „\.o``` P1-1.\:1, MASON COUNTY COMMUNITY SERVICES Permit _J� )`; `-''--, ”1 D
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^ PERMIT ASSISTANCE CENTER:z. •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
41. •0 615W.Alder Street,Shelton,WA 98584MAY 30��
1- �` Phone Shelton:(360)427-9670 ext. •Fax:(360)427-7798 Phone
'tt ^4y Repair:(360)275-4467•Phone Elma:(360)482-5269 �.•
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BUILDING PERMIT APPLICATION 615 .Alder S eet 1
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: ��
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NAME: 5 a/ey11 ,G /neLnie-e/ NAME: 4)� 6 ''
CITY: .5ko-Ibh MAILING ADDRESS: /STATE OVA ZIP' CIT :MAILING ADDRESS: STATE: ZIP: ��G�w c�
PHONE#1: 34,o- Y90 -6 9-9-o PHONE: CELL: 'KI
PHONE#2: EMAIL:
EMAIL: S.,/¢m chaff F7g",.RI/co M1 L&I REG# EXP. /_/ C
PRIMARY CO 'TACT: OWNER CONTRACTOR 0 ?THER = 3
NAME a #v c1,,t•'tk.e/ EMAIL Sa �/+•ak•At42@f'fiat.1C."
MAILING ADDRESS /G/ 6 rr." Rc0'4-5 CITY SYi¢,4ot-t STATEw4- ZIP95frcri( M
PHONE 360—100— (o. 1:) CELL > Z
PARCEL INFORMATION: El
PARCEL NUMBER(12 Digit Number) II 200( - 9 0- clot,4,0 ZONING 67 4 N It 7
LEGAL DESCRIPTION(Abbreviated) Lb (o if cP 3/2I/ FIRE DISTRICT I t SITE Z
DIRECTIONS TO SITE ADDRESSR Ott Rid,E S I �+ CITY S'hG�N D
y1 , i Dr_ nea. - .�s/Ai.o' /„A-e r.
hi,.f I'rt,dnGk on cy OcFt'1' Side of road.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO.gi SNOW LOAD:_pst
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc.) e f z d C H Pe
/
IS USE: PRIMARY.. SEASONAL 0 NUMBER OF BEDROOMS L1 NUMBER OF BATHROOMS.3•S
HEATED STRUCTURE? YES(Whole Bldg)te YES(Parr(s)o Bldg)0 NO❑
DESCRIBE WORK S 7`c hv r/4" �ih?lt i 17 i'. eLe_.e e
SQUARE FOOTAGE:(proposed)
1ST FLOOR 3i,4:3 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/3/? sq.ft. Attachedg Detached 0 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 SEWER 0 / NEW- EXISTING❑
PLUMBING IN STRUCTURE? YES,X NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES)( NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 4 TOTAL BEDROOMS it-
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&void if work or authorized construction is not commenced within 180
days or if constructon 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 DAY OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X S 5/2g4 3
ignature 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 P- z)1 Z. Get `k0
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