HomeMy WebLinkAboutBLD2023-01246 - BLD CD Environmental Health Review - 10/17/2023 MASON COUNTY COMMUNITY SERVICES Permit No: -bill 2bX)-0iA."4(I
PERMIT ASSISTANCE CENTER: RECEIVED
BUILDING a PLANNING a PUBLIC HEALTH a FIRE MARSHAL
615 W.Alder Street Shelton,WA 98584 c
Phone Shelton:(3601427-9670 ext.352•Faz:(360)427-7798 Phone _ OCT 16 2023
40 BeI{air.(360)2754467•Phone Elms:(360)482-5269
BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Shelly Brander NAME: .,
MAILING ADDRESS:545 6th Ave. MAILING ADDRESS:CITY:Kalispell STATE:MT ZIP:59901 CITY: STATE: ZIP:
PHONE#1:406-871-6047 PHONE: CELL:
PHONE#2: EMAIL : r
EMAIL:sfbC&kuhlaw.com L&I REG# EXP.
PRIMARY CONTACT: OWNER 0 CONTRACTOR❑ OTHER[] ,
NAME EMAIL ]D
MAILING ADDRESS CITY - STATE ZIP P"
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 32010-50-01030 ZONING RR5 OCT 1 7202
LEGAL DESCRIPTION(Abbreviated) THE PLAT OF CEDAR GROVE NO. 1 FIRE DISTRICT
SITE ADDRESS 1401 E. BEAVER AVE. CITYSHELTON
DIRECTIONS TO SITE ADDRESS From DT Shelton,Take WA-3N. Right on E.Agate Rd. Right on E. Agate Loop Rd.
Right on E. Daniels Rd. Continue to E. Beaver Ave. She is on left
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO E] SNOW LOAD:2�sf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all thatapply):
SALTWATER E] LAKE❑ RIVER/CREEK❑ POND WETLAND❑ SEASONAL RUNOFF❑ STREAM E]
TYPE OF WORK: NEW❑ ADDITION 0 ALTERATION ❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commerckl Bldg.Etc.)Residence �,
IS USE: PRIMARY ❑ SEASONAL E] NUM13EROF BEDROOMS.__. NUMBER OF BATHROOMS_
HEATED STRUCTURE? YES(whole Bldg) 0 YES(Part[s)of Bldg)❑ ? ❑
DESCRIBE WORK Construct new addition to existing residence within existing deck footprint. Bathroom&entry added.
SOUARE FOOTAGE: !proposed)
I ST FLOOR 102 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK BO sf Ne%. ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTU ATION: *4 COPIES OF THE FLOOR PLAN REQ D*
MODEL
IDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: rl..Jdfw`,�-44�❑0011
SEWAGE/SEWER SOURCE: SEPTIC SEWER I] / NEW EXISTING❑
PLUMBING IN STRUCTURE? YES 0 NO❑ Ijyes, attach completed Water Adequacy Form
PERIMETEXFOUNDATION DRAINS PROPOSED? YES E] NO[] EXISTINGSQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 0 TOTALBEDROOM
OWNER acknowledges Thal bmisslon of inaccurate information may result In a stop work order or permit revocation.Acknowledgement of such is by
signature below.I declare that I am the owner and I further declare Mat 1 am eM81ed to receive this permit and to do the work as proposed.I have
obtairred permission from all the necessary parties,including any easement 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 properly
and structures)for review and Inspection. This permith ppllcaron becomes null&void If work or authorized construction is not commenced within 180
days or If construcflon work is suspended for a period of 180 days.
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
UNTY CODE 14.08.42)
Signature of, t4-T . L__.
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL f,
PUBLIC HEALTH I b r ,
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