HomeMy WebLinkAboutCOM2023-00078 - COM CD Environmental Health Review - 8/8/2023 n,,°y9�G.Pe MASON COUNTY COMMUNITY SERVICES Permit No: (�OYV] Zoe Oda�a
A'• PERMIT ASSISTANCE CENTER: _
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
0615 W.Alder Street,Shelton,WA 98584 "j-y\sVi Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone AUGb O ( 20��
'�i� '' -.11 Beltair.(360)275-4467•Phone Elmo:(360)482-5269
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/tl BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Pion°'School District No.402(Contact Lloyd Smith.Maintenance and Faceless) NAME:TB0
MAILING ADDRESS:"°ESpencerLak.Road MAILING ADDRESS:
CITY:$hp1bn STATE:w" ZIP:98Bm CITY: STATE: ZIP:
PHONE#I:36°426-918 PHONE: CELL:
PHONE#2: EMAIL: AUG 0 8 2023
EMAIL:8 A psd4°2.a9 L&I REG II EXP. / /
PRIMARY CONTACT: OWNER❑ CONTRACTOR 0 OTHER 0 ■ RECEIVED
NAMEEnekson McGo........a(C.A.C<.rySi...se, EMAIL ro. oWo.er»nwe"rn.Lern
MAILING ADDRESS 10iEa.'26Nse••t.5rae3W CITY "`•n" STATE WA ZIP9e'21
PHONE 2s2."'-'m CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 32ee1'21.6e°'e ZONING RRS
LEGAL DESCRIPTION(Abbreviated) PC1OfRUn3-11"Ea0504e2enrorNENW&meNE3nO,PIo•r5LRsoro0L3r1V34 FIRE DISTRICTS
SITE ADDRESS 110 E SPenwr Lake Road CITY sheen
DIRECTIONS TO SITE ADDRESS HT 3 N.RIGHT ONE AGATE RD
IS THE PROJECT WITHIN 300,FT OF SLOPE(S)GREATER THAN 14%: YESO NO 0 SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT'OFTIIE FOLLOWING: (Check au/harapp/ri:
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION❑ REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence.Garage,Cuaunercial Bldg.Etc.)Ad"k"'s"etbn ORow,too agacent SChww15
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS NUMBER OF BATHROOMS'
HEATED STRUCTURE? YES(tt'hoteBldg)Q YES(Pm'tlslrfBldg)❑ NO❑
DESCRIBE WORK New module/Welding to replace removed modular Wilding tot state adorn offices
SQUARE FOOTAGE:(pn,poscs)
1ST FLOOR's69 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 sq.ft. Attached 0 Detached 0 CARPORT sq.ft. Attached❑ Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE Modular Commercial Budding MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER 0 / NEW Q EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO❑ bees,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES Q 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 fora 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
Pf.4;(7 ,Ge— COUNTY CODE 14.08.42) I
X � NER Must be signed by the OWNER) d4=VQ
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL �
PUBLIC HEALTH .2J1_ -7 +//4 atiii f eteld_ett
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