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HomeMy WebLinkAboutBLD2023-01000 - BLD CD Environmental Health Review - 8/23/2023 DacuSignEn eooeID C8Gd1D18-9885.488D.9FEF-CAE518188CE8 MASON COUNTY COMMUNITY SERVICES Pere:R 1(o: )& 0 3 O1QOn PERMIT ASSISTANCE CENTER: r r- ,t ' .Bu,LO NG.pt anlnrm,G•Ptrstk HEALTH,FIRE MAiau froisr as ., lot.. Oti W.Alder Simi.View,WA 96584 Phone Shaw(360) (:14274070 eat 352•Fax O:427.7>48 Phone AUG 2 3 2O f R r.(38O)?75-a4dr•(-?Ionia t (J60 4824262 i! 'BUILDING PERMIT APPLICATION 615 W. Alder Street Z I PROPERTY OWNER INFORMATION: ; CONTRACTOR INFORMATION; I NAME? Charles Henry_r NAMEiSOUTH SHORE CONSTRUCTION INC MAILINGS AC)t)RESS:_,2g8u Ash GtQYB.AI j MAILING ADDRESS:PO BOX 963 "� CITY:COn , -_STATE: 7_LP__30�4, CITY BELFAIR _STATE:WA ZIP:98528 m PHONE WI:364-277_-77.D l PI IONE:360.275 1818 CELL: ..__ i > Z PHONE N2: . . EMAIL:8oulttsliore®q corn - i g EMAIL..:robflath96@gmail.00m LBcI RE:C,q SOUTHSC016NL Exp. D2f 10 f2024. = m PRIMARY CONTACT; OWNER 0 CONTRACTOR t OTHER _ __.------ Z NAME EMAIL • MAILING ADDRESS CITY STATE ZIP. . PHONE 'CELL (" PARCEL INFORMATION: PARCEL.NUMBER I12 Digit Number) 32127-53-00168 _ •ZONING RR 1 1 LEGAL DI SCRIPTION(Abbreviated)_LAKE L,JMERICK 4 TRACT 1QQ S 40(29 FIRE DISTRICT tLJ Sfl E ADDRESS 2550E Mason Lake Rd _ crry Shelton AUG 2 5 DIRECTIONS To SITE ADDRESS�eadnodh.00iNA.31ot-2/mIles.tuin�teft.onta E Masimlalss Rd 2.6 1023 miles destination will be on the right. IS THE PROJECT WITHIN 300 IT OF SLOPEtS)GREATER THIN 14%: YES"] NO RECEIVED IS PROPERTY WITHIN 200 PT OF THE FOLLOWING: triter*dll Mai appIrt SALTWATER❑ LAKE[] RIVF.RACItt:l.'K 9 POND El WETLAND LI SEASONAL RUNOFF o STREAM 0 -•1 TYPE OF WORK: Now Q' ADDITION❑ ALTERA I ION❑ REPAIR 0 OTHER 9 i USE OF STRUCTURE*Waite.r under,r u..vn•,ahug:14e 1 Residg(ice IS IJSE PRIMARY SEASONAL.° NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 2 HEATED STRUCTURE'? YES r1r'iwnh Node,it YES r,ar+(•l4,>,liN u NO 0 DESCRMEWORK Install hew MH For realdertttat use r $OUAJtE FOQTAGE;rpmpndriri 1ST FLO OR$12 tI ft. 2ND FLOOR_._.__..sq It 3KDFLOOR sq It. BASEMENT sq..It DECK _w,sq.it .COVERED DECK_ sq,It STORAGE .sq.(L OTHER ,iq.tl GARAGE sq.i1. Anacllr+d❑ I)cw had G CARPORT - sq.ft. Amulled[J Deruchcd MANUFACTURED HOME INFORMATION: 3s3 to ill COPIES OF THE FLOOR PLAN REQUIRED* MAKE Golden West _ _monk. m•©rea 36R7�J YEAs2023, i.>;No tr 38' _____ WIDTH WIDTH 4' _. • RFDKO OMS 2 BATHS 2 __,SERIAL,NUMBER NJA_ '�_.1 ENVIRONMENTAL IIP.At.TH: VII SEWA(M JSEW ER SOURCE: SEPTIC V SEWER El 1 NEW 0 EXISTING.� Yam— L �L� PLUMBING IN ST ILE`T T:T URI`1 YES % NO Q {/•Pet,attach c� irled WWerd p Puna CJ�' PERIMERIF�OUNDATION DRAINS PROPOSED'' YEN n NOV SX STING SQ;1l EXISTING BEDROOMS PROPOSED BEDROOMS 2 — _ TOTAL BEDl OM$2 OWNER xhnoefadpas this atehtrwaion at t,aoarrate i iIoralarim may rear'in a Nap nee alder at wait nesg4Gon.acklensbnlbernani at suds is by signature Wart I Aedten than t wen ma~et and 1 Maher docIwa hat I am a rdiesd es moony thin peek and In do ha walk as proposed..oaad.I rove obnload pahnisaan Tram addle asaaasary perUas.and,dInq any elnanenl balder orpanes at loaded!raQpdr q ibis prom Hs*~or ar*pal repiesMO/6YM.*meats Doi the bdoenadcal prodded la=undo and grants anpbyaes at Nampa Carey mama b ha above daeerlbad prapaly and i Jm walk'(sI n poe,ba it nTor a wedwanesnes nA i void Wreak ix wdtoaaad constructionisnot am pnama wAhd i 1 ands le at ISO days IN PRO.O,IaoOV CONYNUATION OF WORK ON Ttifs*ERNIITIS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERI1.TAPPUCAT1ON OF 1 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON COUNTY COOS 14,0a42) 51. x _ : . 1 2.1.1zosti Slpn8Iun of OWNER{Must brilbovel be the OWNER) Date • D£PARTME TA I.REVIEW APPROVED DATE DENIED DATE TAGSANOTESICONDCIIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH R � I1a[tAuit:Si _ l �fi'Z� tr i a g v a D C I trl N ~ ' tO 11'-1 On 11'-10" m 1 I 1 x * i y x 5 �/ F N N m IC;; i Y 3 1 PI III co oh N 1 . ■ g II W - p o0 i • mia ■ by -- — 1Z1 3W - p / co ..i., ,6 -6.: III ubo le � N CS I I i ° 3 4 00 C7 2 fl •iv = c•- 41 i , A. GWN O ■ z Wi. 1 - W CT =M. . is y_ —ICD �. 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