HomeMy WebLinkAboutBLD2023-00926 - BLD CD Environmental Health Review - 8/24/2023 , '� MASON COUNTY COMMUNITY SERVICES Permit No:
/ PERMIT ASSISTANCE CENTER: H E C E I` 'F D
j ^ 2` •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARS v
0 615 W.Alder Street,Shelton,WA 98584
r � } Phone Shelton:!360)427-9670 ext.352•Fax:(360)427-7798 Phone
Belfair(360)275-4467•Phone Elma:(360)482-5269 J U L 1 7 2023 ENVIRONMENTAL
V I R O N M E N TA L
r
BUILDING PERMIT APPyIpA,jIO,m S it HEALTH
PROPERTY OWNER INFORMATION: CONTRACTOR IFORMATION:
V
NAME: Li r s U- NAME: 0(4)1n(�N,f
MAIL D S: 0 ( MAILING ADDRESS:
CIT . S STATE: ZIP. Z CITY: STATE: ZIP:
PHONE#1: _ ‘70-7 q.- ,- j PHONE: CELL:
PHONE#2: EMAIL:
EMAII�T S(��f►V/t1.DII L&I REG# EXP. / • / 10
PRI Y CONTA T: OWNED CONTRACTOR 0 OTHER❑ 7J
NAME Yi.I Se�'h EMAIL scume- AUGAE 2 4 423
MAILING ADD ESS P_ CITY STATE ZIP
PHONE 1.-rY1(r CELL --fl'1 . RECEIVED
PARCEL INFORMATION: n
PARCEL NUMBER(12 Digit Number) . 2 )I D-j(� '1 O _ _ ZONING R'2 I /iv
�,L LEGAL DESCRIPTION(Abbreviated) I(ft[L ()
I
efs. ( e- LOj S FIR DISTRIC
SITE ADDRESS E3D CITY
.CTION TQ SITE ADDRESS i I / 0 r. '‘
ty IN- 1--I S; _ tw' : t- . ..,, • t i,4- %i , . L) ?-
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO,KSNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE 0 RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW, ADDITION❑ ALTERATION REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Etc.) Re 5(d t 6 Qi
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS % NUMBER OF BATHROOMS 2.-
HEATED STRUCTURE? YES(Whole Bldg)g YES(Parris)of Bldg)❑ NO 0
' DESCRIBE WORK
SOUARE FOOTAGE:c (proposed)
1ST FLOOR 1a)0 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK ft. STORAGE sq.ft. OTHER sq.ft.
GARA5742 sq.ft. Attached Detached CARPORT sq.R 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/2' SEWER❑ / N EXISTING❑
PLUMBING IN STRUCTURE? YES/a— NO❑ f yes,attach co red Water Adequacy Form •
PERIMETER/FOUNDATIO S PROPOSED? YES NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOM / 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 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 --'Jill/ 7) { k/ a3
Signature of @INNER(Must be signed by the OWNER) I Date
DEPARTMENTAL VIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH 1417 1, eTTUA/11,/��
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