HomeMy WebLinkAboutBLD2023-00996 - BLD CD Environmental Health Review - 8/23/2023 e y'r \ MASON COUNTY COMMUNITY SERVICES Permit No: 1/�(I 40e// -- 0)- i L
PERMIT ASSISTANCE CENTER: RECEIVED
C E I` f E D
' 4::,,,*
:�, •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL K C v
3 1I!• I 615 W.Alder Street,Shelton,WA 98584
:,:;- Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
\ ,b' t `;dy Belfair.(360)275-4467•Phone Elma:(360)482-5269 A U G 2 3 2023
ru.70 1
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMA TON W. Alder treet
NAME:Jk4c-i .4- Jq/r ..,,:. Aft 1J -1 NAME: `.
MAILING iDDRESS: 7) ,4-. , iv ry MAILING ADDRESS: RIM
She f1 STATE:IVA-'ZIP: f fIYY CITY: STATE: ZIP:
PHONE#I: 1( 0 V 10 7 PHONE: CELL:
PHONE#2: '2..,r1 3 7 7 ('7 i.? EMAIL: AUG 2 5 2023
EMAIL: A re_ 6 e d 9 e../;✓t• c a--t L&I REG# EXP._/_/ RECEIVED
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑
NAME 5'Q4ri•,a /1/G4c 1 EMAIL bred ?P' e/: �-6-4,-'k j
MAILING ADDRESS 70 r=Ent.y/ LI0 Y CITY r(.e/tor, STATE4✓1 ZIP2 Y
PHONE 3dQ V9U 9 SiS CELL 5CiM!
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 2 if L rY'- 7 7-9(2O /f ZONING 9/
LEGAL DESCRIPTION(Abbreviated)'TtZ$11-3 O1 St" 7 />L-v .'fl- FIRE DISTRICT 3
SITE ADDRESS //O a ✓,'' yeled ?+r, CITY -5hG/r`'7lr-
DIRECTIONS TO SITE ADDRESS ('lay 3 —j Pi - n`r-/__'t d. S-i-rD Itd_
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO1 SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEWX ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence.Garage.Commercial Bldg,Etc) kL 1'i d.t.,tGf
IS USE: PRIMARY) ' SEASONAL❑ NUMBER OF BEDROOMS rI/NUMBER OF BATHROOMS I
HEATED STRUCTURE? YES(WholeBldg))ZI YES(Part(s)of Bldg)❑ NO❑
DESCRIBE WORK
SOUARE FOOTAGE:(proposed) 1
1ST FLOOR sq.ft. 2ND FLOOR /t ea sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft
DECK 3 Z/q sq.ft. COVERED DECK sq.ft. STORAGE_ =sq.ft. OTHER sq.ft.
GARAGE /9 sq.ft. Attached j) Detached❑ CARPORT sq.ft Attached; Detached❑
MANUFACTURED HO INFORMATION: MP *4 COPIES OF THE FLOOR PLAN REQUIRED*
MODEL . YEAR LENGTH
TH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC g SEWER❑ / NEW❑ EXISTING'e
PLUMBING IN STRUCTURE? YES NO❑ Ifyes,attach completed Water Adequacy Form /
PERIMETER/FOUNDATION DRAINS PROPOSED? YES g _NOD \ EXISTING SQ.FT. 19
EXISTING BEDROOMS PROPOSED BEDROOMS I____.7_—_ TOTAL BEDROOMS_ I
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 _ 7429N1.93
Signs ure of O NER(Must be signed by the OWNER) Da
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL U '` J �,jJ�
PUBLIC HEALTH 1'/ -t�f(1 c C I/ILL — /'e
Uy/ I O/LUC.3
APPROVED ..�A �.r_M_.r �.«...
MASQN COUNTY DCD PLANNING
SCOTT RUET AICP
RR5 Zoning L_ �� — l),3 C_s i .°0
Front Yard Setback. 25'.
Side & Rear Yard Setbacks. Residential dwelling • 2•2_,\28-"I rl-9c'30(3
and accessory structures is 20'.
OR 10%width of lot if not more than 100' wide
OR approved ADV
`3
Digitally
Scott a signed
r
Scott
RuedyI N./ I
35
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I(/ I 45-47
'I NAP G l c , r'
A i i
S, • 0
Irty`w4 fHV . I ite!..01 .0.
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'.� rop •S , 1.03 t,n
iOC3.;9 1.) Me'.,?AULA JOY JO;iNSON .y41 R �O !
I.IC�NsI:"�� �� I � t_.
D(PIAES !1 `�- U 5;• 4I
E Setbacks y v/Xsa '� II Il la�?�.7..,.e 1
A.) Drainfield/Reserve req es 10'setback from footing/foundations 1 / + tom_ �n . J
B.)Septic tank(s)requires 5'.etback from all footing/foundations / I J I L —'(•~��#
C.)No foundation/Perimeter r, ains within 30ft,downgradient of I{
Drainfield/Reserve areasi: .
D.)No Cut Bank(s)(greaterrth Rand over 45 degrees)within �O\e'e
50ft.down gradient of DrainVlVd;•eserve area /
\ % ,
EH APPROVE* \Do <�1 r,.. Ste)
Rhonda Thompson 09/26/ 023 / IT r
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