HomeMy WebLinkAboutBLD2023-01254 - BLD CD Environmental Health Review - 10/17/2023 :; `4. MASON COUNTY COMMUNITY SERVICES Permit No:1,141 2.D2 "O1 5'
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\ PERMIT ASSISTANCE CENTER:
1 •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL RECEIVED
„ill, 615 W.Alder Street.Shelton,WA 98584
Phone Shelton:(360)427-9670 ext.352•Fax (360)427-7798 Phone
iv.s ._.^a Beltair(360)275-4467•Phone Elma:(360)482-5269 0 C T 17 2023
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BUILDING PERMIT APPLICATION �� �
A 15 W. Alder Strcct
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:� VO
NAME:iti(,.G i TEJ� -NAME: F�d'Y� ink �.: .„A u Z )'
MAILING ADDRESS:CI Cc • ' MAILING DRESS: i spy 30 0 Vi' S';z 5
CITY: ' . STATE: ZIP:^ CITY:/2(1�i!e5yler'STATE:te-v9 ZIP:¢� e-
PHONE#1: PHONE: - ELL::,V70 cit./b 7
PHONE#2:, (,) •�tc j) . 47 l EMAIL: �yrl4 hk/ e CCX t-d 1 "2 6l3 NJ 1/ z
I E , /7p �L,&I REG# CKPI erTf 3V,V EXP.slip
PRIMARY CONTACT: OWNER 0 r CONTRACTOR% OTHER❑ =
DO
NAME j✓11 obtik cc Lt>/f if EMAIL m 0
MAILING ADDRESS I 1°J. C., n07' ter, sw CITY Kv E� STATE Wf ZI P9 ' 79'
PHONE CELL Cf 7n 8-e/6 I 706 D Z
PARCEL INFORMATION: y / %J --�
PARCEL NUMBER(12 Digit Number) L/2)2 s-77_ t�1.7'7 4l! ZONING (`('S = m
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 3 O C L�y 1��-TO v P1 CITY SlieijLc'( D
DIRECTIONS TO SITE ADDRESS r
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO IA4NOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply)
i SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW TKDDITION❑ ALTERATION 0 REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence.Garage,Commercial Bldg.Etc.) ( 6'5( a„..i(tee
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS ,� NUMBER OF BATHROOMS .�
HEATED STRUCTURE? YES(Whole Bldg)❑n YES(Rani's)of Bldg)) NO❑
DESCRIBE WORK -5 1 VL l.+-� �"4Q lk4 t )y lY�"/e- Li f - jf1/�lrv,"17 42
SQUARE FOOTAGE: ro sed
Q (P po )
1ST FLOOR !7,5Vq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK`2 sq.ft. COVERED DECK 7.4 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE 642 sq.ft. Attached Detached❑ CARPORT sq.ft Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF 18I.FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW EXISTING❑
PLUMBING IN STRUCTURE? YES NO❑ If es,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES NOD
� 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 8 void if work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUAT ON OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATI OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
/ 07/6 7:2_3
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ENTAL REVIEW APPROVED DAT1. DENTED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH t(441;5 c `1, I s CLACLA
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