HomeMy WebLinkAboutBLD2023-00796 - BLD CD Environmental Health Review N' P'n:1,.. MASON COUNTY COMMUNITY SERVICES Permit No: ej�J ( — /y0 7Q(0
l PERMIT ASSISTANCE CENTER: Q r_ �.J ��J
t \
rto •BUILDING•PLANNING-PUBLIC HEALTH.FJRE MARSHAL E C E I V E�__
675 W.Alder Street,Shelton,WA 98584
y L. ....,.✓""� Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
��2UJ. " - 44y Beak:(360)275 4457•Phone Elma:(360)482-5269 J U L .1 3 2023 ENVIRONMENTAL
•til•3es.
BUILDING PERMIT APPLIWTvv.N , AidCr Street HEALTH
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:iF/C 14�)1 M/C'gi 1EL .5I15E1L7 NAME:SAME
MAILING ADDRESS:4/90 5E ALtIIEAVE MAILING ADDRESS:
CTTY:5I-ELTdrti STATE: VI14 EPP: 48.584/ CITY: STATE: ZIP:
PHONE#1:34,0—229-1334 PHONE: CELL: .
PHONE#2:Jae,-54,I- O Z S 7 EMAIL:
EMAIL:M1e1-111EL.6EI$Ee7@)9AIL.Cam TM REG# EXP. / / r fa► >'
PRIMARY CONTACT: OWNER,) CONTRACTOR❑ OTHER ElSu11 _
NAME 54)./.4.6 4' .4,1 0 V E EMAIL AUG 2 4 2023
MAILING ADDRESS CITY STATE ZIP _
PHONE CELL RECEIVED
PARCEL INFORMATION:
PARCFT NUMBER(12 Digit Number) 3,q0 4!- 5 3-east,9? ZONING
LEGAL DESCRIPTION(Abbreviated) L 1 9 FA k6 Ai L A$. P I V tie FIRE DISTRICT
SITE ADDRESS SAME AS 4.13,9VE city
- DIRECTIONS TO SITE ADDRESS I-hwy_.3 TD CID ,2O. TstPe Li2g147- IA ra:):7Ih1Alt17Xt
611e.ar i•47op Cpuoi-tl AL-pi tJe Av .�nID 6FR�Pelt TZIC. !-rr
LS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO❑ SNOW LOAD: psf •
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LASE 0 RIVER/CREEKS POND❑ WETLAND❑ SEASONAL RUNOFF STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATIONX REPAIR❑ OTHER ❑
USE OF STRUCTURE(Besidenot Garcgt mQ iaiBIdA Ere) A 1 LI
IS USE: PRIMARY in SEASONAL❑ NUMBER OF BEDROOMS_ I _NUMBER OF BATHROOMS
HEATED STRUCTURE? YES� (Whole Bldg) YES mi[r]ofBldg)❑ NO❑
/
DESCRIBE WORK ( i 1-1CL(YA' . C.: L)`�t-7-
SQUARE FOOTAGE:(proposed)
1ST FLOOR-115(1 sq R 2ND FLOOR sq.$ 3RD FLOOR sq.ft_ BASEMENT sq.f.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTBER sq.ft
GARAGE sq.R Att,rhed❑ Detnr•hed❑ CARPORT sq.ft.Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: • *4 COPIES OF THE FLOOR PLAN REQUIRED*
• N. MODEL - , T F'NGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: _
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑ E ISTTNG$
PLUMBING INSTRUCTURE? YES' NO Ifyer,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOD EXISTING SQ.FT. 7 SD
•
EXISTING BEDROOMS d PROPOSiJBEDROOMS ( TOTAL BEDROOMS /
OWNER admowtedges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.1 declare that lam the owner and I further declare that I am entitled to receive this permit and to do the work 25 proposed.I have
obtained permission from at 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 bewrnes null&void if work or authorized constnrc5on is not commenced within 180
days or if construction work s suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLI ION 180- OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X -5-a9 as
Signature of OWNER(Must be sinned by the OWNER) Date
:.`DEPA-KIM ?VIAL REVISR= •' APPROVED•,-4 DATE"= DENIED:;.._PATE...!.'TAGS/NOTES/CONDITTONS'R
BUILDING DEPARTMENT
•
PLANNING DEPARTMENT .
FIRE MARSHAL
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