HomeMy WebLinkAboutBLD2023-00625 - BLD CD Environmental Health Review - 7/20/2023 MASON COUNTY COMMUNITY SERVICES Permit No:LjJL1Ja�IOa3-00&;15
PERMITASSISTANCE CENTER: RECEIVED�•
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHA!
615 W.Alder Street,Shelton,WA NNA
Phone ort.(30)42746 352.
Elms:
..(37-7 BPhoneMAY -S 2023 ENVIRONMENTAL
Bel/
gq� �/�/ Alder Street HEALTH'
BUILDING PERMIT APPLICATION 19H
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: JUL 2 0 2023
NAME:Bob 8 Ruth Thoresun NAME: RE'3EIVED
MAILING ADDRESS:3371 59th Ave.SW MAILING ADDRESS:
CITY:Seattle STATE:WA ZIP:98116 CITY: STATE: ZIP:
PHONE#1:2063796303 PHONE: CELL:
PHONE#2: EMAIL:
EMAIL:Inamiews@msn.com 4L&I REG# EXP.
PRIMARY CONTACT: OWNER❑' CONTRACTOR❑ OTHER❑
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 1 21 08-50-01 01 5 ZONING FIRS
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 380 E. Lombard Rd. S. Grapeview WA CITY
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑+ NO❑ SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (check all thatapply):
SALTWATER❑' LAKE ❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑+ ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER [] Replacement
USE OF STRUCTURE(Residence.Gamgc,Commerclal B/dg.EIc.)R851deOCe
1S USE: PRIMARY ❑' SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 3
HEATED STRUCTURE? YES(Whole Bldg) ❑v YES(Panfs)ofince❑ NO❑
DESCRIBE WORK Remove and replace existing residence within existing footprint.New deck,patios,and concrete walk to be installed.
SOUARE FOOTAGE: (proposed)
BASEMENT 1285 sq.ft. MAIN FLOOR 410 sq.ft. UPPER FLOOR38�Jsy. g.
DECK 180 sq.ft. COVERED DECK 38 sq.ft. STORAGE sq.ft. PATIO 272 sq. ft.
GARAGE sq.ft. 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:
SEWAGEISEWER SOURCE: SEPTIC❑v SEWER❑ / NEW❑v EXISTING❑v
PLUMBING IN STRUCTURE? YES ❑' NO❑ Ifyes,attach completed Water Adequacy Form
PERIMETER TOUNDATION DRAINS PROPOSED? YES ❑+ NO[] EXISTING SQ.Fr. 511
EXISTING BEDROOMS 2 PROPOSED BEDROOMS 2 TOTAL BEDROOMS 2
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.)declare that I am the owner and I further declare that I an entitled to receive this permit and to do the work as proposed.I he"
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this pmlecL The owner or legal
representative,represents that the information provided is accurate and grants employees of Meson county access to the above described property
and structure(s)for review and inspection. This pennB/application becomes null 8 void if work or authorized construction is not commenced within 180
days or X construction work is suspended for a period of IN days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT 15 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) 2
X� �- /z ��(Z J
Signature Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED I DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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