HomeMy WebLinkAboutBLD2023-00895 - BLD CD Environmental Health Review - 8/1/2023 '•
,� MASON COUNTY COMMUNITY SERVICES Permit No:e:21..,0 anaz- cog?
/. .\ PERMIT ASSISTANCE CENTER:
I,^. I ril- i .BUILDING••6 5 W.PLANNING
Alder Street Shelton, A 98584FIREUBLIC HEALTH• MARSHAL RECEIVED
i',"i F J Phone Shelton:(360)427-9670 exL 352•Fax:(360)427-7798 Phone ^����c MENTAL/ Belfair(360)77.5.4467•Phone Fin . rvrhm4f '-r„Fo MAY 2 5 202.N V 1 l •
BUILDING PERMIT APPLICATION
. _ T'ta
PROPERTY OWNER (1pc(.
INFORMATION: CONTRACTOR INFORMATION: A,Ir
NAME:t.)50.1N RO'nS NAME19111C CcX15r11C{IOYI HVV 0 12013
MAILING ADDRESS. 0•sox g- MAILING ADDRESS:3 t°tD W11e-�f' S - R�
CTTY:`Pori 0 STATE: . • ZIP. '3(�(v cITY:co r�0� .O STATE:In(A ZIP:• i•-. DE/VED
PHONE#I,i_7-2 5-'2._'�O PHONE;;;' -2 2 -2109 CELL: SC.t. -2_,
PHONE#2: EMAIL:Pi nnp(li .0 S}✓IJ(-4-AY>s(0 SV g rnd.+I Lei'
EMAIL:G W \ 0e ar ct)0 6(1?)p, C3(r l ,191L1a REG#f DIM*(fl 4_110.6 r14 EXP. /3O/.:2..0L$-
PRIMARY CONTACT: OWNER 0 CONTRACTOR, OTHER❑ -f
NAME here K '_�pp r.( . 6Yl EMAIL ()tl";(\aCA�.000 ru0-415(flS rnQ,4`r C'
MAILI ADDRESS ' I al.D �(),�n 4 1?C� ,� CITY 0. t 0 UC�TATE�POk ZIP ( 32(g ;o
PHON � ]57-�.2 c,--24 CELL 2J S- Z2 - 2� O (
PARCEL S7`INFORMATION:
PARCEL NUMBER(12 Digit Number)(3.11)\1--'S( D O 1.c 2_ ZONING Q Q 5
LEGAL DESCRIPTION( bbreyiated)111(n '(l\i ... .CA 1((}- 1 C. FIRE DISTRICT
SITE ADDRESS % w 11A 6gC\ (L( »I LC_ITY�Q_\_11 l
,......,DIRECTIONS TO SITE ADDRESS r 0�TA; U..1 Pt J 2j Iy C. i l i C� A r �� or, A50,
Tm'x� {ft,�.4 , t)T, p take.Wo t. oh r = Poi lc (08p , Le or. \-�\ c PUN P� Jul o()
1 IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO gi. SNOW LOAD:_psf 1)----c4
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND❑ WETLAND SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW 5:e ADDITION 0 ALTERATIIOnNrt❑ REPAIR❑ OTHER 0
m tZ
USE OF STRUCTURE(Residence.Garage.Cvmerciad Bldg,Etc.) { 3 )(..1 4 CQ i
IS USE: PRIMARY'] SEASONAL 0 NUMBER OF BEDROOMS r. NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)N YES(Parris)of Bldg)0 NO❑
DESCRIBE WORK 1.fla `\-tf l -OP YYAC)S\k j c CAL l...►"C d \A(7( _
SOUARE FOOTAGE:(prof rued)
1ST FLOOR1 Rq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.R BASEMENT sq.R
DECK re"C) sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.fL
GARAGE sq.ft. Attached 0 Detached❑ CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 rCOPIES OF THE FLOOR PLAN REQUIRED*
MAKE (VIcv�4k� MODEL£OLJE I CC ID YEAR 'g q 1` LENGTH / ,e.� Q
14
WIDTH BEDROOMS �
BATHS SERIAL NUMBER --V 1 ce?)(47n�t L7
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC V SEWER❑ / NEW It- EXISTING 0
PLUMBING IN STRUCTURE? YES jit NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO, EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS c-9, 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 permitlappfication 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 3 °� IV,�U3 3-- I 6 j-3
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENTED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL ,A/��,n, f
PUBLIC HEALTH \ 4V13 J 3 � `T.snfO21
yof cf),\-tc. 12o cl - St- oots2 4
cox, 2oZ1,- oo?.q
• Scc.IQ, 1,, ; W ��
PLN Approved
Q / 08/29/2023
Mason County Community Development
Gavin Scouten
t ) All Changes Subject to Approval
- -I
Planning Setbacks
./4 7. \ . .
Front: 25'
Side: 7'
.7 A , Rear: 20'
V,R, a'�� *all setbacks measured from the farthest
4 \ 9-; \\ projection of the building
subject to EH.setbacks
\vo1/41 Secondary possible tank
I r, () et'' --I- location
, - \
j . \'\
t ` i ' A'
\ NO i
/(. 5/' ektfl o�(,k. \\ 2' minimum with
• WA12022-00099
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• EH Setbacks
I A.) Drainfield/Reserve requires 10'setback from footing/foundations
' 3i B.)Septic tank(s)requires 5'setback from all footing/foundations
G �6 O 0 V P
C.)No foundation/Perimeter Drains within 30ft.downgradient of
Drainfield/Reserve area
•2c1 i , `, D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within
1 � \ .� 50ft,down gradient of Drainfield/Reserve area
V
y I V1 a '( EH APPROVED
-..b.- t •• Rhonda Thompson 09/13/2023
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