HomeMy WebLinkAboutBLD2023-01082 - BLD CD Environmental Health Review - 9/12/2023[NAME:
MASON COUNTY COMMUNITY SERCES ��'}e mit No 1PERMIT ASSISTANCE CENTER: _ .•BUILDING•PLANNING•PUBLIC HEALTH.FIRE MAR L SEP I Et I V E� z615 W.Alder Street,Shelton,WA 98584 ZRECEIVEDPhone Shelton:(380)427-9870 ext.852•Far:(380)427-7798 ggBeHeir(380)2754487•Pharie Ekne:(380)4B2-5289 ZOZJBUILDING PERMIT APPLICAT1611$ W. Alder Street D ZOPERTY OWNER IINFOOR 1M.ATION: CONTRACTOR INFORMATION: fTl u.)�.T JO-Vl02A44' NAME:HIune Nome.AILIN A ESS: MAILING ADDRESS:113as62NDAVE E
TY: Il H STATE: I CITY:PUyNU)P.WAN373 STATE:WA ZIP:99373 9
ONE#1: • 5- PHONE:2s3-T/o-2244 CELL:
ONE#2: EMAIL Prec lm&1anQhulnehohne&c
AIL: h F+ G&t REG#naINH•B836D EXP. 11 /OS/23
IMARY CONTACT: 0 NERQ� CONTRACTOR❑c9 "'"OTHER +1 �1 t
NAME U3I� EMAIL ,I _LISP t.1 q/GLMA.LII(pH/
MAILING ADDRESS ! CITY 5jJe I�N1 STATE I'M U ZIP CR.S F)
PHONE CELL !c-
PARCEL INFORMATION: z /�
PARCEL NUMBER(12 Digit Number) J0 ` 7 — 9� 13Z ZONING
LEGAL DESCRIPTION(Abbreviated) �,.0} `�Df S� 1�7q •Z !t}- FIRE DISTRICT
SITE ADDRESS CITY
DIRECTIONS TO SITE ADDRE S /
aA .-FIIWVIIAh 1 7-kA IgzF± 6nin qia M4 r oEj
IS THE PROJECT WITHI 300 FT OF SLOPE(S)GREATER THAN 14%: YYES[] 1a NOk SNOW LOAD: osf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: fchrckdtrharoppty): norw— Isj /6
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM ❑
TYPE OF WORK: NEWg ADDITION❑ ALTERATION 9q REPAIR❑ OTHER ❑
USE OF STRUCTURE(Heaidenre,Goragv,Cammerdal Bldg,Ere.) Kes td-ug Ce—
IS USE: PRIMARICRI� SEASONAL❑ NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS Z. ,T
HEATED STRUCTURE? YES(whole B/dg0- YES(PadIsl oJBldg)❑ NO
DESCRIBE WORK 0 of kow W G.Ad
Q
S UARE FOOTAGE: ('m ourdg
1ST FLOOR sq.ft. 2ND FLOOR/ sq.d. 3RD FLOOR&sq.ft. BASEMENT sq.ft.
DECK sq,. ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARA W sq.ft. Attache me ed❑ CARPORT sq.R. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: "4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BED O MS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: ,,J
SEWAGE/SEWER SOURCE: SEPTICgg,„ SEWER❑ / NEW EXISTING ❑
PLUMBING IN STRUCTURE? YES NO❑ Ijyes, attach mpleted Water Adequacy Farm
PERIMETER/FOUNDATION DRAINS PROPOSED? YE K N EXISTING SQ.FT.
EXISTING BEDROOMS rI PROPOSED BEDRO MS���r++NNN TOTAL BEDROOMS
OWNER acknowledges that submission of Inaccurate information may result in a stop vvork 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 Mis project. The owner or legal
representative,represents that the information provided is accurate and giants employees of Mason County access to the above described property
and structure(s)for review and inspection. This pernit(appliwlion becomes null&void 8 work or authoraed construction is not commenced within 180
days or 6construction work is suspended for a period of 180 day.,
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 �jJJJ 4
7 `
mi a OWNER Mist a signed by the OWNER) /y
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSINOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH G1v�1
z
1bo' .t PEHThPPROVED
aA
3
2O TO' 1 �K`14L.L
EH Setbacks
�-24 yAes �Q� A.) DrainfielNReserverequiresl0'setbackiro fmbngrfoundaW.
B.)Septic tank(s)requin s 5'setdsck hom all lootingtloundatons
G.)No foundatioNPerimeter Drains WiMin 30ft,downgradient of
' I DrainfieldlResene area
D.)No Cul Benk(s)(greater than 54and over 65 degrees)within
SOR,down gradient of Drainfield/Reserve area
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PLN Approved �-
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Planning Setbacks --'!
Front 25
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Rear:SO
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