HomeMy WebLinkAboutBLD2023-00829 - BLD CD Environmental Health Review - 8/1/2023 MASON COUNTY COMMU! SER Permit No:,adAD-q3-a76:R
PERMIT ASSISTANCE CENTER: ��
BUILDING•PLANNING•PUBLIC HEALTH•FIRE MAT
E C E I V E D
615 W.Alder Street,Shelton,WA 9aM4AUG.0 20A2y39 I Phone Shelton:(360)427-9670 exL 352•Fax:(360)927Jnea[J ��� 3 2�23
Benir.(360)275-4967•Phone Elms:(360)482-5RECEIVED J
BUILDING PERMIT APPLICATIO 5 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: NAME: ter.
MAILING ADD SS:._ A.57 A MAILING ADDRESS:
C1TY:()ntltlt d .j_STATE:_WK. ZIP: CITY:-,,A -r,,w .STATE: c, ZIP:_gr.�rvrt -
PHONE# - H.•.- PHONE:,Yeo-9-:2 s.rn CELL: 3;Ap-4�_o+�?_
PHONE#2: EMAIL:
EMAIL: feq co L&I REG# c ISeaA EXP. 2i z
PRIMARY CONTACT: OWNER❑ CONTRACTOR® OTHER❑
NAME -r EMAIL r
MAILINGADDRESS /6/ _cP a�mf.er �r CITY StN_uuJ STA E, .c ZIP
PHONE,It-in- u43 z/✓;! CELL MW-V96tvs/ey
PARCEL INFORMATION•
PARCEL NUMBER(12 Digit Ntaaber) ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS t 75h �—_ ln4604/ /x Ad- r./_ CITY ls,,,0, a", t ILIA.
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESN NO ❑ SNOW LOAD: Z&--psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Cheat all drar,ryPry):
SALTWATER[] LAKE R RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW[y' ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER 9 'QNKQ 165F1*
USE OF STRUCTURE(&.da¢e,Gars Cavee WB/dg,ft) !=
IS USE: PRIMARY B SEASONAL❑ NUMBER OF BEDROOMS 7 NUMBER OF BATHROOMS J
HEATED STRUCTURE? (while fildgl❑ YES(Parf(a)yB/dg) ❑ NO
DESCRIBE WORK M
lJ
SOUARE FOOTAGE: (pmpored) �j yll ,ll�
1ST FLOOR 840 sq.ft. 2ND FLOOR le%L__sq.R 3RD FLOOR sq.ft. BASEMENT, sq.R a
DECK%.�jQ0- _sq.ft. COVERED DECK /�sq.ft. STORAGE sq.ft. OTHER sq.fL
GARAGE sq.fL Attached❑ Detached❑ CARPORT 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 N SEWER❑ I NEW N EXISTING❑
PLUMBING IN STRUCTURE? YES 18 NO❑ Ijyes,attach completed Water Adequacy Form
PERIMETERTOUNDATION DRAINS PROPOSED? YES ID NO[] EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS Z TOTAL BEDROOMS
OWNER ackrwvdedges that submissbn of Inaccurate information may result In a slop work order or permit revocation.Acknowledgement of such is by
signature below.I declare drat I am the owner and I turtle,declare that I am emltled 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
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