HomeMy WebLinkAboutBLD2023-00972 - BLD CD Environmental Health Review - 7/7/2023 r
Pt+f:1, MASON COUNTY COMMUNITY SERVICES Permit No: n 7R,
PERMIT ASSISTANCE CENTER: �a2i:: 3 V O`�/
BUILDfNG ••PLANNMG•PUBLC H111L7N•FIRE MARSHAL R E C E
c 615 W.Alder Street,Shelton,VJA 98584
Phone Shelton:(360)427-9670 ext 352•Fax(360)427-7798 Phone E NIV I R O N�VI E N TA L
,,,' s'e Belfair.(360)275-4467•Phone Lima(360)482-5269 �23
BUILDING PERMIT APPLICATION _ 2L L HEALTH
4r Oiv:trEe
PROPERTY OWNER INFORMATION: CONTRA�bhR II�TFO
4 NAME: C CIS- .SPAN NAME: Old,✓ 4
MAILING ADDRESS: 740 LE- d'//ce:/,'.t/.:'D/J/,D MAILING ADDRESS:
CITY: /f 1 i Yam' STATE: LIP: CITY: STATE: ZIP:
PHONE#1: ,i'O 6%22 -Cp7.3 PHONE: CST.: -
PHONE#2: 136 -, i.i -/R 7i/ EMAIL:
EMAIL: (•Cc,/.>Oc'./JcG j le ter.:/-Gorn I 'T REG# Fes. / /
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER❑
NAME EMAIL •
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
• PARCEL INFORMATION:
t PARCEL NUMBER(12 Digit Number) /22 Sex 7.CC'O/0. ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
c SHE ADDRESS 7'o 6 (5165G1Pzc*74 / `;ii/4i.s',','.7 /2 CITY 4iL fA/
• DIRECTIONS TO SITE ADDRESS F ie/9--3 iv e 6/ufC.,,kl"c,0 rA.-6 Ad A'iLek.1
MCA/) is 6f/0, 'r2T 15 i_Ai.- LA.ii /lay se? (N /fie. kaw,
IS 1131`.PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO❑ SNOW LOAD: psf -
IS PROPERTY WITHIN.200 FT OF Hilt FOLLOWING: (Cheek all that apply):
SALTWAILtL❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Resider c,Garage Commercial Bldg.Etc)
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE?` YES(Who-k'e''Bldg)❑ YES(Pan[r)ofB7dg)❑ NO❑ /
DESCRIBE WORT ( 1 I►Y 11 I'I Ci t) t-t-' i i�C.1�.L� `�l&1 L4_C'
• SQUARE FOOTAGE:(propasdd)
1ST FLOOR C sq.fL 2ND FLOOR sq.ft 3RD FLOOR sq.ft BASEMENT s .m.ft
DECK sq.ft COVERED DECK sq.ft STORAGE _ sq.ft. OTHER pi; sq.ft -i hVOO 1Y1
GARAGE sq.ft At/nr•hed❑ Detached❑ CARPORT sq.ft Attached❑ Detached❑ •
MANUFACTIRED_HO INFORMATION: - *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE ---------
AA$ MODEL L�DIG
r
Wjl)TH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
/
SEWAGE/SEWER SOURCE: SEPTIC/0 SEWER❑ / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES/Z NO❑ Ifyes,attach completed Water Adequacy Form
PERT ETER/FOUNDATION DRAINS PROPOSED? YES❑ NQe EXISTING SQ.FT,
EXISTING BEDROOMS PROPOSE..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 are 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 at the neressay parties,Indudng any easerient holder or parties of interest regarding this project.The owner or legal
representative,represen's that the information provided is axrrate and gam employees of Mason County amass to the above described property
and sbu ure(s)for review and inspection.This pemnit/appliication bermes null&void ti work or authorized construction Is not commenced within 183
days or i`construdion work is suspended fora period d 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)
_/----,. Z7.7.— --- *VZ 9/2 5
Signature of OWNER(Must be sioned by the OWNER) Date
_kvrases � •...--- .- -- ..
::'DEPAWMENTAL REVIEW;-_::;APPROVED: DATE-='.::_DENIED i.- DATE .'TAGSINOTES/CONDITIONS t_
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FEE MARSHAL
PUBLIC HEALTH 2/ 7 ///
J
F�-
Z
=
C 0 w � �a
.x
1 > moe
CO Z
C..?: w
C
0
W m '
N
O
N
W
e$ i.
EXISTING GARAGE DOOR
i
2.
uy do 80
U
g
0
H
N
.
L of r.
.9.S18.9.
_ i
l
I,
IIt
0 I
z ip
x i $
w . 1 i
'41-
•
..9:„t.. .St/S1 S L. K
.
ir u
f N_
9
22
W
' ! .!2 P.
W m Sm V ala WE
III
J WZ C T, O
p u t god a mm O. W J
2 et t Q O xF x x u t°
p z ° a Li.9 K N O g awC ° ct ° dm
Z W
3 a-
W ";� t
X s 2 `g $ m H tt„' a •i
4 Z 6 J Q .Q O
C K p - FS x U h
S W H O i =
W
2 V C 2 W : O WoUfZW0zU pa °an
WM
Q !-
xOW Z mx 6W Hf Y t • a ° W
J ; W O , Wp
m U
J U W m U 6 J° Z J p O
j t W Z Z t J O ; t
Z W i U L ;Z -y u Ili
4 % m m ; i v K N O a i/ ,
O J J J O U t t O CF
E ; ; R t W# U< IA
C w N m p O% x,ti S 0 H
f< ? J J J K m D O O O O
- h s T b O p ;
.a
�r �.
EXtsTINO OARAOR DOOR
ii is
•
V y
z .��
n
. un
V V
f
Y byy
1 ,
__
— H
1
t •