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HomeMy WebLinkAboutBLD2007-01641 - BLD CD Environmental Health Review - 9/19/2017 ��r�rir o� C 1 `-I i . / MASON COUNTY PERMIT NO. I�wOc 1 7 ViU(- `�` � BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 9 il di‘:, She on (360) 427-9670 • Belfair(360) 275-4467 • Elma (360) 482-5269�/ Onthewebwwwcomasonwa.usA LIC IN i'O 41ATI CONTRACTOR INF RM T O A Owner - ! Company NameMailin Ad ress., G: Y Mailing A dr ss- � City •,_..Stat Code Cit State l� Zip Code X_ Phone —. Other Ph. Phone g Other Ph. Lien/Title Holder—. Contractor Reg. # Exp. E mail address. E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER ti3YSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Water System Name of Water System �y PARCEL INFC)RM.I\TION- 12 Digit Parcel No _:5-4.-"e l5 Yc )o ():3 Fire District Legal Description_. // i Site Address (Please inclluu set name,street number and ty) 5 c , .-9�y ,47,2e - / ' � Directions to situ—, /" '- '�. /f -'1-0 //J ©� ` Will timber be cut and sold in parcel pre aration? Yes/No Is property withi- 200' of Saltwater Lake River/Creek Pond Wetland _Seasonal Runoff Stream Slopes or Bluffs > 15% _ Is this permit subi:nittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Y Mo TYPE OF JC.B - New X Add Alt Repair Other PRIMARY RESIDENCEkSEASONAL ❑ Use of Building)_. Describe Work No. of Bedrooms_. No. of Bathrooms Square Footage- 1st Flo r 2nd Floor izi 3rd Floor___Basement Deck Covered Deck Other Sq. ft. -_ I Garage Attached Detached - Carport Attached Detached _ MANUFACTURED HOME INFORMATION -Make Model _Year Length Width Seri LNe_ u of Bedrooms roomsi��ef Type of Heat__—. Purchase Price$ Replacement Uni . es/No Installer Name .�: - Certification No. OWNER/BUILDER Pci:nowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by signatur below.I declare that I am the owner;owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained permission from tham to apply for this pe it and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided is accu to anc grants e oy s of as n County access to the above described property and structure forforreview and inspection. II PROOF Kt I S OF PROGRESS INSPECTIO —CD-7 X 1—, ' /L Date• wne Jwnels Repre entative o6tractor (indicate which one) �' FOR OFFIC .1Ct-tt YOND THIS POINT Accepted by: ,-�"fIJ1/4.J9\' v Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department OOr-1 -�� Planning Department . p DM 7 • �-rj,-)13 1'+� Environmental I-lealii Department J/07Tia •- - �t� `6) t� 0 Public Works Department J Fire Marshal V -- (f s�i1 C -' FEES Building Permit Fee Site Inspection �-sr-_, Plan Review Fee EH Review Fee .`J✓ Plumbing & Bare Fee Planning Review Fee Mechanical & Ease-ee Other Wood/Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY DEPARTMENT OF HEALTH SERVICES June 07, 2007 PO BOX 1666 Shelton WA 98584 Shelton (360)427-9670 Fax (360)427-8442 JIM ROBERTSON Elma (360)482-5269 408 N BRIGHTON BURBANK CA 91506 Belfair (360)275-4467 Case No.: BLD2007-00915 Parcel No.: 321207590203 Dear Applicant: Your building permit cannot be approved by Mason County Environmental Health until the following are completed and turned in: Well Log Please call me at (360)427-9670, ext. 554 if you have any questions. Sincerely, Trish Woolett tw@co.mason.wa.us Environmental Health Mason County Health Services Comments: 6/7/2007 1 of 1 BLD2007-00915