Loading...
HomeMy WebLinkAboutBLD2023-00421 - BLD CD Environmental Health Review - 4/20/2023 • , �+"�•`''-14nr MASON COUNTY COMMUNITY SERVICES Permit No:61,...0 C-3—oc (��` PERMIT ASSISTANCE CENTER: •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL r C r7 1\I r'N rill, I 615 W.Alder Street,Shelton,WA 98584 ;$: L. t�.i� P; Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone ) , ENVIRONMENTAL \`;:'-- -'I j;,-,..IC� Belfaic(360)275 4467.Phone Elm:(360)482-5269 ++ 1 y ` (� e LT H BUILDING PERMIT APPLICATION ;5 old. Alder street PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: NAME:IK .4r4E rk-(1e:6,, G. 1-1-i 1- - NAME: MAILING ADDRESS:P C t yt:43C � MAILING ADDRESS: CITY:ALyti STA E:WA ZIP:4Ii %'"I CITY: STATE: ZIP: �� PHONE#1: D'Jj -gee, (01'�Q PHONE: CELL: C-�c r tJ 2: EMAIL: EHMAIL:#Ke_ t-R l t•.1-611 c) Ao L t (L AA L&I REG# EXP. / (— APR 2 O [ui 3 t► i.- ONE PRIMARY CONTACT: OWNS $ CONTRACTOR 0 OTHER❑ _ � NAME lam-•1t.k.TN (, �E►`12 C' �"�' 11't" EMAIL(1-GN-1' i 7a �/ RECEIVED MAILING ADDRESS P. O. I0C')< •4 17 CITY lS. YO,L i-1-- STATE wA 21•s :L7Y/' PHONE C•ji e. (7(j1C CELL PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) Z-1-1 -7-- t.- OOU' ZONING 1 l— LEGAL DESCRIPTION(Abbreviated) pi G,614y(2 g a FIRE DISTRICT SITE ADDRESS .."77 I E A .s•I 7 tvA. Atagw„44,Y CITY 64 \(j-i•VS1f-� DIRECTIONS TO SITE ADDRESS N-�r1 " It '/K�� � fg gE14 n P� C i• AA r a�l�C1i i/�. f�d.K--C�-KV A�1 IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO/ECSNOW LOAD:__ps( IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply) SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM❑ 4 TYPE OF WORK: NEW 0 ADDITIONX ALTERATION❑ ff REPAIR❑ OTHER 0 USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc) "1 `` 1©` GF' IS USE PRIMARY SEASONAL 0 NUMBER OF BEDROOMS - NUMBER OF BATHROOMS Z •7 HEATED STRUCTURE? YES(Whole Bldg)0 YES(Part(s)ofBldgJ NO 0 � �.` DESCRIBE WORK tA1�17i14Gc pQ-/V$i✓ l/ } 2 •' ■�314�/ LAW 1 Y�Y� SQUARE FOOTAGE: (proposed) ��11 1ST FLOORtp4( sq.ft. 2ND FLOOR T�12 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft. DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft. GARAGE ,{6, sq.ft. Attache Detached❑ CARPORT sq.ft. Attached❑ Detached 0 MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER / NEW 0 EXISTING% PLUMBING IN STRUCTURE? YES4 NO❑ If yes,attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES' NOD EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signature below.I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF180-D.QYS OF MORE WILL CAUSE4 THE APPLICATION TO BE EXPIRED.(MASON COUNTYCODE ('' ate - /1726)� 5 Si nature of OWNER(Must be signed by the OWNER) DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL ' c-4..-$\\.,` n PUBLIC HEALTH - t 3°«3 lNW 44344Al 1 94586 VM'M31A3dVHO o AVMNUVd VNOHGVW 3 11£ Y— !I!Hue>1 /O!uowPpV 1e!luepisau Z O Q) i i i i . � c.u- > o -o I Z e aivii A O O c }} g d p U Cc o c9 3 °}Y t, 3 Z E i W d 4 1#`it ti W _ 01 ash 9�8'`� k� 4 ag Ni O in Q .Q cL W O __ jr ---ass -- -_1Ykcry O W L_< 1 `. / .: / / / ii Z P' / / L1.J XiI / / / c� I/ 1 / 1J j / J1J / / '�1 , r % 5II Ai 1 .5'4 1,11ea / '§° / , q.. 1 ill / 1 / I /, , / / / / ti I - ----_____ J / bi / / 5b aCo 3