HomeMy WebLinkAboutBLD2023-01435 - BLD CD Environmental Health Review - 11/30/2023 a
ed
MASON COUNTY COMMUNITY SERVICES Permit No:
PERMIT ASSISTANCE CENTER:
.BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL RECEIVE
A-
615 W.Aker Street,Shalton,WA 98584 4!,Phone Shelton.(360)422-9670 ext.352•Fax:(360)42]-]298 Phone NOVvn 9
Beffirk(360)2251462•Phone Elm is(360)482-5269 N 2 8 2023 9F 1 - -
BUILDING PERMIT APPLICATIO t15 W. Alder Street c `
`cam
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Frank Ssde NAME:
MAILING ADDRESS:162314M Awe SE MAILING ADDRESS: ,
CITY:orompw STATE:WA ZIP:M501 CITY: STATE:_ZIP:
PHONE#I:360-260-3443 PHONE: - CELL: 'T
PHONE#2: EMAIL.
EMAH,:mancabl3®ar t.rwA L&I REG# EXP.
PRIMARY CONTACT: OWNER 0 CONTRACTOR❑ OTHER[]
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 4212 75-00050 ZOMNGRIO
LEGAL DESCRIPTION(Abbreviated) TR 5 OF SUW 1311538 S Win FIRE DISTRICT '
SITE ADDRESS 169/Eagle Food or. CITY Shelton,WA 965s4
DIRECTIONS TO SITE ADDRESS Take Nwy 101 N,R on E Eagle N or,twt he on the leR
IS THE PROJECT WITHIN 300 FT OF SLOPES)GREATER THAN 14%: YESD NO❑ SNOW LOAD:25 f
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checkausnatoppl,):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW 0 ADDITION O ALTERATION ❑ REPAIR❑ OTHER
USE OF STRUCTURE lae.IMncs Gangs,Cammremial Bldg Erc.)Residence s Shop
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS 1 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole Bldg)O YES(Purgf)ofBldg)O NO❑
DESCRIBE WORK Reserves 4 Shop shin pole wilding awdure
SOUARE FOOTAGE: (,v Pared)
1ST FLOOR togs sq.ft. 2ND FLOOR sq.R 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK 220 sq.ft. STORAGE sq.ft. OTHER_sq.ft.
GARAGE 560 sq.ft. Attached 0 Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: w4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC 0 SEWER O / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO❑ Ifyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOO EXISTING SQ.FT. 0
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 1 TOTAL BEDROOMS 1
OWNER acknowledges that submlaebn of loomarete Information may result In a slap work order or permit revocation.Aokras edgemenl of such is by
signature below.I declare that I am the owner and I further dedare Nat I am entitled to moolve this permit and to do the wale as proposed.I have
obtained permission from all the necessary ponies,Induding any aesemant 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 slmcture(s)for review and inspection. This pri mNapplication becomes null 8 void if work or authorized construction Is not commenced within 180
days or it mnstmdion work Is suspended for a period of 180 da,r.
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)
XRachel Weber Dates 2023n0si16ft
4w-9mo 10/25/23
Signature of OWNER(Must be sinned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED I DATE DENIED I DATE I TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH