HomeMy WebLinkAboutBLD2021-01679 - BLD CD Environmental Health Review - 11/16/2021 MASON COUNTY COMMUNITY SERVICES ` ( � 7
PERMITASSISTANCE CENTER: Permit NO:
`.•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL C^�'��D
615 W.Alder Street.Shelton,WA 98584 C
Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7I98 Phone
Bel/sic(360)275-4467-Phone Elms:(350)482-5269 N11 162021
BUILDING PERMIT APPLICATION 615W. Alder Stre
pt
PROPERTY OWNER INFORMATION: CONTRACTOR INFORM//ATION:
NAME: /F ,-'egtE eF!/Feco'ezw NAME: -5&'rhCT✓l`dx05
MAILING ADDRESS: A' 76 MAILING ADDRESS: 451 G"
CITY:-46
t/ STATE: 4iiF ZIP: Ss CTTY: Bflgl,Q STATE: +.9 ZIP:
PHONE 01: eiz e'Itb 33z5' PHONE: CELL: 3AD Sd5?
PHONE#2: EM41L : $-Cl�w2
EMAIL: e—v L&t REG# VVJF 3yC-D/ EXP. / /
PRIMARY CONTACT: OWNER a- CONTRACTOR 3 OTHER
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION: NTAL
PARCEL NUMBER(12 Digit Number) ZGNINGHEALTH
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS / C��IT�Y�
DIRECTIONS TO SITE ADDRES �it9xe .PG —�i�T 4N'E.5?`./,�Wtrtotf•AI• .J11EI/rIArP 4P✓E..
Pa LaP'Will IflQW aw .*riiae e s
i �rFr.v E' WX 4 w, � /Y/�
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO[jam
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (cheuxeunor epp(P):
SALTWATER❑ LAKE ❑ RIVER/CREEK POND ❑ WETLAND ❑ SEASONAL RUNOFF❑ STREAM
TYPE OF WORK: NEW[ADDITION❑ ALTERATION ❑ REPAIR❑ OTHER
USE OF STRUCTURE(Roblemx.Grange.Commemlul Bldg.Etc) /� lbFilis/ePL
IS USE: PRIMARY[]SEASONAL n NUMBER OF BEDROOMS NUMBER OF BATHROOMS Z
HEATED STRUCTURE? YES(Whole Btdg1 B� YES(PoegyofMoV❑ NO
DESCRIBE WORK /V�ra jJ9F6. .4067F
SOUARE FOOTAGE: rp,r,a.e.extra„
1 ST FLOOR AGI sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq,A. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE 4:g n Jicti✓ MODEL D4lS/GOCIF YEAR LENGTH
WIDTH .2J BEDROOMS_K BATHS 2 SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW D] EXISTING❑
PLUMBING IN STRUCTURE? YES 2— NO❑ IJves, attach completed WaterAdeguacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NODK EXISTING SQ.
EXISTING BEDROOMS PROPOSED BEDROOMS 41 V TOTAL BEDROOMS
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elarmW,n beW.ltleebm MM I mtlnemxrentl bMrtledemtlut I om anMaa b mnNe1M16 pmmina boa aieuefa n Palmea.l M1an
aalalnea ps-ih#rM1vn N W Yle¢®ryPPes.IndYtllna w'Yerertient M1olaar orpeNm ollnbrl rylerenp Nb pyetl.llieawnerwlryY
mgrenbdre:nrrenaa Vu[NelYaatmelM lvoNtlea le Uon enapnn4xnplayass WMeson GwMy eccalidw IeEwa Gnmroo gopctry
ena awnwahl rarmlevaM ImpeNon mb PamNeppwedpn b.mmes null avela ilwoMareNma:m mrwman Ye Mcmnmenma wmb IN
aeye s rcmaeeammaoarb.rP.naearoe p.aaa atm a.ye.
PROOFOFCO INUATIONOF ONTHISPERMIT IS BYMEANS OF INSPECTION. INACTINTYOFTHIS
PERMFAP ICATIONO B DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(NASON
COUNIYCODE 14.08A]I
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Slgnelura NOWNFR(Must be elvned Mthe OWNERI Dela
.YAFPAtZT�['>}'AD .,. vf>'PR �� � T&- ` ':D 'T4`".'TArn?A'IOTBSfCONAFlLSRVH :
BUB.DINGDEPARTME4'f
PLAHININGD WATMENT
FIRE MARSHAL
PUBUCHEALTH '$)
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EH Setbacks
A.) DrainlielNReservereQWret,U) setWcklmmfoolin,00andalions
B.)Deplic Units)requires 5'si from all Naar rigifoureallans
APProXthattly Ct No fouMauoN isheirer Drama wnnm Son.LowngrMlem of
1 Dramried/Reserve area
Dr)No Cut Bankfst(greater than 5X aM over 45 degrees)within
lad dean down gradient of DrainnalNRaserve area
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EH APPROVED
Rhonda Thompson 10/302023
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reserve
b C l o w cseanont
l�A tic Tank
2-Comp00 n Sep
2- oartment with
Effiueat Filter
O1100'Gallon Pump Chamber
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RECEIVED P 11t
ADLA JIOYaJOHNSON'
. .d'E'Ef9 StGNEft_
NOV 16 2021
615 W. Alder Street
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