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HomeMy WebLinkAboutBLD2023-00574 - BLD CD Environmental Health Review - 7/27/2023 � •.� "`a •PL/1'1`1 f MASON COUNTY COMMUNITY SERVICES Permit No: ,� 'O 57 r615PERMIT ASSISTANCE CENTER: R E C E IV IRO •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL 00114 l I• i�I W.Alder Street,Shelton,WA 98584 HEALTH =�I. ,4' Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone MAY 2 2 2023 -7, ,`y Belfair:(360)275-4467•Phone Elma:(360)482-5269 ��.,,,:;��t` 11 W. Alder Street BUILDING PERMIT APPLICATION UL PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: 2 i Z023 NAME:TOM ALLEN NAME: RECEIVED MAILING ADDRESS:20 SE Teagle Dr. MAILING ADDRESS: CITY:Shelton STATE:WA ZIP:98584 CITY: STATE: ZIP: PHONE#1:3602290507 PHONE: CELL: PHONE#2: EMAIL : EMAIL:tallen81@gmail.com '4 L&I REG# EXP. /_/_ PRIMARY CONTACT: OWNER© CONTRACTOR 0 OTHER❑ NAME EMAIL MAILING ADDRESS CITY STATE ZIP PHONE CELL PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) 22028-21-90040 ZONING RR5 LEGAL DESCRIPTION(Abbreviated) TR 4 OF GOVT LOT 1 TR A OF SP # 1244 FIRE DISTRICT SITE ADDRESS 20 SE TEAGLE DR. CITY SHELTON DIRECTIONS TO SITE ADDRESS SOUTH ON N 1ST ST FROM DT SHELTON. LEFT ON SE. ARCADIA AVE LEFT ON SE LYNCH RD. LEFT ON SE TEAGLE DR. SITE IS ON RIGHT IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO © SNOW LOAD:25 psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND❑ SEASONAL RUNOFF 0 STREAM 0 TYPE OF WORK: NEW 0 ADDITION © ALTERATION ❑ REPAIR❑ OTHER ❑ Int. remodel USE OF STRUCTURE (Residence,Garage,Commercial Bldg,Etc)Residence IS USE: PRIMARY 0 SEASONAL ❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 2 HEATED STRUCTURE? YES(Whole Bldg) 0 YES(Part[s]of Bldg) 0 NO 0 DESCRIBE WORK Construct new addition to exist house and basement storage.Make interior renovations to existing residence to improve spaces and function. SQUARE FOOTAGE: (proposed) 1ST FLOOR 293 sq. ft. 2ND FLOOR sq.ft. 3RD FLOOR sq. ft. BASEMENT sq. ft. DECK sq. ft. COVERED DECK sq.ft. STORAGE 279 sq.ft. OTHER sq.ft. GARAGE _ sq. ft. Attached❑ Detached❑ CARPORT sq. ft. Attached❑ Detached❑ 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 0 PLUMBING IN STRUCTURE? YES 0 NO 0 Ifyes, attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT. 120 EXISTING BEDROOMS 2 PROPOSED BEDROOMS 2 TOTAL BEDROOMS 2 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 OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON COUNTY CODE 14.08.42) X 5-22-23 Signature of AGENT Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL ( ��Q PUBLIC HEALTH Y2'v' ( l'i Z2, L(I j n' CktC .9 4 , a* 4 I fi @ Ifli iliii1 Ieyii1I1I f !}" �pf `1. 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