HomeMy WebLinkAboutBLD2023-00693 - BLD CD Environmental Health Review - 5/11/2023 rig,
&50` •"`'tt:t-,t MASON COUNTY COMMUNITY SERVICES Permit No: 0 e 69,, / 'C)0IY '
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PERMIT ASSISTANCE CENTER: [� \ f D
P.
BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL P.E C _--.
615 W.Alder Street,Shelton,WA 98584
�y Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone MAY 1 1 2023
Beltair(360)275-4467•Phone Elma:(360)462-5269g
BUILDING PERMIT APPLICATION
615 W. /\iger Sheet
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMA ON:
NAME:ithAttCk t Oehor`,,k Kok..( NAME: ,,,ram S (t./
MAILING ADDRESS: (.304. 75 - S MAILING ADDRESS: Po etk. 7 03
CITY: SC s kfkf STATE:co A ZIP:¶B iic CITY: 1)./.- STATE:w_ oq ZIP: f 852 y
PHONE#I:(ZO6� 7o7 -L,667 PHONE3C0)SU7-lf3 1 L: r.,
PHONE#2: EMAIL:`' S1�hlc b.,;1 crs l� Alai./•Cditi. ,2
EMAIL: LAI RE�# 3".A N 5 W b D3'EXP.3 /7,3_II45- <
PRIMARY CONTACT: OWNER 0 CONTRACTOR la • OTHER 0� = J J
NAME 5A oa) S+ s '�C'.(w EMAIL ,JJ Stook tCy bur 1 t rs SMgi I•Caiv` m p
MAILIN ADDRESS r , 66), 793 CITY Pr f vs-. STATE w/} ZIP Y SS77
PHONE 170) S4-17—/8 L1Z CELL
PARCEL INFORMATION: r
PARCEL NUMBER(12 Digit Number) Z"ZZ33•S% -00008 ZONING m
DISTRICT o, 7ric S Z
LEGAL DESCRIPTION(Abbreviated)� i/�c5 � 5 t�u�*�� 7 --1
SITE ADDRESS wit, a• /'11gy„r� (K• nl 1 )ES'/ CITY rt Ie.
DIRECTIONS TO SITE ADDRESS ✓lqw". f k• q to I i &i I e% 'vest- , I—
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO Q SNOW LOAD:LSpsf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE I RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEWg ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)ilf)i r.VLGe
IS USE: PRIMARY 0 SEASONAL pf NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 3
HEATED STRUCTURE? YES(Whole Bldg)A- YES part[s.1ofBldgl 0 NO❑ 1
DESCRIBE WORK e,vwve ex i i Z, k c e — 6 pia A.G•+-' Una
SQUARE FOOTAGE:(proposed) r
1ST FLOOR i .'L, sq.ft. 2ND FLOOR S4/6 sq.ft. 3RD FLOOR sq.ft. BASEMENT 1/2.7 sq.ft.
DECK L07 sq.ft. ..'COVERED DECK 3S sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE Cr.et sq.ft. AttachedjJ Detached❑ CARPORT sq.ft. Attached❑ Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
0 MAKE _ MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC,] SEWER❑ / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YESZ NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ] NOD EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 3 TOTAL 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&void if work or authorized construction is not commenced within 180
days or it 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)
ign re of OWNER(Must be signed by the OWNER) Tate
EPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL (jfi�n /-`,,,�.r�,,,�
PUBLIC HEALTH 0 a latooz3 l-v,�lA�f"c*5 ot ck
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