HomeMy WebLinkAboutCOM2022-00085 - COM CD Environmental Health Review - 9/22/2022 (mac,(A 20 000S5
o�```•r'-'t'Y MASON COUNTY COMMUNITY SERVICES Permit No: 1 �
y^ PERMIT ASSISTANCE CENTER: •;� -.,t...i s~:t. t j,
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y •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
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Z ffill•1 I o 615 W.Alder Street,Shelton,WA 98584
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�j. f �,;' Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone v J\'V (;�� • (S .2^2
1, Bellair:(360)275-4467•Phone Elma:(360)482-5269 r � 9 „'Iw
BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: ar14r% (,; '42ff0vn NAME: S.1_ F Ott
MAILING ADDRESS: J 2t :idY .37cD MAILING ADDRESS:
CITY:e2(Zx,_r` STATE:c.o�tq ZIP: '3,')5-z; CITY: STATE: ZIP:
PHONE#1: 3(oa 21c) 4 SS PHONE: CELL: G
PHONE#2:_2, e, 27g' Sk 7-2--i EMAIL: Xi
EMAIL: dr-b r:«e.e_},e:4-de-e :rt L&I REG# EXP. /____./_
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PRIMARY CONTACT: OWNER 4l.. CONTRACTOR❑ OTHER 0 > Z
NAME /9 b, ✓� EMAIL
MAILING ADDRESS CITY STATE ZIP El
PHONE CELL
PARCEL INFORMATION: 7fe'S-
/PARCEL NUMBER(12 Digit Number)(232 1 - if2 -bb(-)2.0 ZONING&.1m /Ii`'i /_LEGAL DESCRIPTION(Abbreviated) PGL 2e•( 3' LA (7 -2-6 FIRE DISTRICT mC:/4 FA r
SITE ADDRESS 2.' c t1 E 5r4rE 2 r 7Dv CITY ;3i-i..Fly i.
DIRECTIONS TO SITE.ADDRESS _ �F .* Zb'•4,
c-re,. - 3,4e; CG No) SF S yr/ii/le
IS THE PROJECT ITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NOB SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK❑ POND 0 WETLAND❑ SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW�' ADDITION❑ ALTERATION 0 REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Garage.Canunercia!Bldg,Etc.) d m d2-7 c_f c:c.,
IS USE: PRIMARY fa' SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Part(s)of Bldg)0 NO2 I -(;-.) re--
DESCRIBE WORK 1Ce e.) Ge3-7.--r.s.71/'4.-'e.A:1'1e1
SQUARE FOOTAGE:(proposed)
1ST FLOOIej'f)) sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE _ sq.ft. Attached 0 Detached 0 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: a:n•e o.--1n�eJ,L
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER / NEW EXISTING'g QXr s 4,),--, T3-,e
PLUMBING IN STRUCTURE? YES(_ NO 0 If yes,attac • mpleted Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? Oar NOW'. EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER acknowledges that submission 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 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 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 property
and structure(s)for review and inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or it construction work Is suspended fora iod of 18 days.
PROOF OF CONTINUATION OF K 0 THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
P -1iPPLICATION OF 1 0 D YS F MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
�/ COUNTY CODE 14.08.42)_
re of OWNER(Mu be signed by the OWNER) D to
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
•
I FIRE MARSHAL
•
PUBLIC HEALTH 4`c \��i 1//2 CM 4 tfi LtA.sn , 1 o