HomeMy WebLinkAboutBLD2023-00820 - BLD CD Environmental Health Review - 7/20/2023 MASON COUNTY COMMUNITY SERVICEPermit "00 8 20
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(/;:ipl-0:r'Nr PERMIT ASSISTANCE CENTER:•. ..,•BUILDING•PLANNING•PUBLICHEALTH•FIREMARSHAL ��^��.tf�t��} �j sts w.Alder Street,Shelton.WA e8584 ,UL L
�-t.I• Phone Shelton.'(360)427-9670 exL 352•Fax:(360)427-7798 Phone
Beifaic(360)2754467•Phone Elms'(360)482-5269 A1d e r Sir e et rn
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BUILDING PERMIT APPLICFI► b _ Z
C
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: JACK JT= NAME:TRiti:11" CJserRuGTiON 5=Rvice5, LLC 0
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MAILING ADDRESS:121 ci-AweTr L Da N MAILING ADDRESS: el N CLALLdx In PI_
CITY:NooDs=oRT STATE:WA ZIP: sSE45 CITY:Noor,-..s>:cRT STATE:WA ZIP:9S54S >
PHONE#I: 509-539-3> 43 PHONE:253,263.3341 CELL:
PHONE#2: EMAIL' rvp344% i^.viTrce.1G T
EMAIL -><vss,•,.cow
I.&I REG II TRINIGSS52L2 EXP. 61301202 _, 1z,
PRIMARY CONTACT: OWNER 0 CONTRACTOR® OTHER 0 --I
EMAIL c�osf39TR,�:r-c )-L c D
NAME C o:ESS T"loas i-t.^.0O5PORT STATE WA ZIP`8.54e. r
MAILING ADDRESS Sl N G �i CITY
PHONE 253.2E73,3341 � CELL
PARCEL INFORMATION: ML�t]
PARCEL NUMBER(12 Digit Number) 422055200011 ZONING REF,
LEGAL DESCRIPTION(Abbreviated) Lace Ct:9•+-!AN •15 LOT 11 FIRE DISTRICT IS — JUL Z O 2023
SITE ADDRESS 1441 N Pct—s7cH DR CITY }-iMDSOORT 1.:_
DIRECTIONS TO SITE ADDRESS mom US-ION ts:crt L o*i'o WA-l19 N. TucN L AT N S-g.V*sTiLL R. 5 s' RECEIVED
-;;R•. R A- N 5Ttr.yT:_ D2 N, pROF-ER-� c' L
IS THE PROJECT WITHIN 300 FT OF SLOPES)GREATER THAN 14%: YES❑ NO[ SNOW LOAD: -2. ps
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Chuck all that aptly):
SALTWATER❑ LAKE 2 RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW B ADDITION❑ ALTERATION 0 REPAIR❑ OTHER (-I
USE OF STRUCTURE(Res/de ux.Gorse Cal Bldg.Etc) RES e=
IS USE: PRIMARY 0 SEASONAL El NUMBER OP BEDROOMS 2 NUMBER OF BATHROOMS 1
HEATED STRUCTURE? YES(wink Bkfg) I YES maN1s/of t#Jg)0 NO❑
DESCRIBE WORK N54i SFR
SQUARE FOOTAGE:(proposed)
1ST FLOOR 1,200 sq.R 2ND FLOOR 500 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.*. COVERED DECK 25S sq.It. STORAGE 220 sq.ft. OTHER sq.ft.
GARAGE sq.ft.Attached 0 Detached❑ CARPORT 216 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 0 / NEW 0 EXISTING Q
PLUMBING IN STRUCTURE? YES Ei NO❑ If yes.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.
EXISTING BEDROOMS C __ PROPOSED BEDROOMS 2 TOTAL BEDROOMS, 2
ouvNEw,a,na,A.doaa that submtcoon of inarlvmte information may resutt 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 cntiued to receive this penntt ana to 0o me won(AS pt.sm d.t heave
obtained permission from all the necessary parses,including any easement holder or parties of interest regardng this pm)ect. The owner or legal
1 representative,represents that the information provided a accurate and grants employees of Mason County access to the above described property
I and structure(s)for review and inspection.This pernitlapplication becomes null&void if work or authorized construction is not commenced within 183
days or if consbudion 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 APPUCA OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
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Signature. ER(Must be sinned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT /'
_FIRE MARSHAL O I(,l/ L} L�n�f !I._.,, a�C� ,� I
PUBLIC HEALTH I/a I ]i ie
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