HomeMy WebLinkAboutBLD2023-01271 - BLD CD Environmental Health Review - 10/24/2023 MASON COUNTY COMMUNITY SERVICES Permit No: I(� U�i�) D I
�" �P-• PERMIT ASSISTANCE CENTER:
`�' • . 7�, ••BUILDING••PLANNING•PUBLIC HEALTH•FIRE MARSHAL ,.-, ,
RECEIVED
D.. 615 W.Alder Street,Shelton,WA 98584
'mow•�'. T I • Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
`� :� "`� ` '" 0 C T 19 2023
Wit. Be/fair(360)275-0467•Phone Elma:(360)482-5269 73
ro
BUILDING PERMIT APPLICATION
61-5 W. Al-deg' Street 2
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: VA
NAME: Man s ELVcS NAME: Elie (e...15ikitc-I ICIJ r�
MAILING ADDRESS: t27c:,5 r4.4ha 11)A;,A) MAILING ADDRESS:53 sE (a h;4 x 0 J
CITY:?I(7 II : STATE:IAA ZIP: .S 3 L CITY:SOCi iGr.. STATE: t.va j r ZIP: 6,4 y
PHONE#1: /Szf) u32-/173 PHONE:(3(C>1gG.3 15c10ELL: ;Arr..,:"
PHONE#2: EMAIL:
EMAIL:_4:4,1t t✓c'S C? «ie;iiC.'ikf,i:s: }./o.vt L&I REG# EXP._/ / w =
PRIMARY CONTACT: OWNER CONTRACTOR 0 OTHER❑ L.
I-
NAME .)A.vt E �S Lv EMAIL j,.KELF.•-.• AO-1 .;.' f(ItirST./('M
MAILING ADDRESS 1 L7cci i/-1+J4Gr 2 .X. IJi., 1 CITY(tlq Mat STATE i.V:l ZIP !t i�L
PHONE CELL /'<<O U32 - i17 3 SW
PARCEL INFORMATION: _Ct
PARCEL NUMBER(12 Digit Number) (,,(^I2-C1 DO,I X) ZONING
LEGAL DESCRIPTION(Abbreviated) ')I'" (Dt":7.5 es ',i t.%/,t' -Y>`� FIRE DISTRICT ,i z
SITE ADDRESS. ' 1 ( C.t�(.'(1((..p( (li) .t LU"1 t CITY htei_-41 r4 , L1 1
DIRECTIONS TO SITE PfDDRESS _ ) 1)
141-c -i'• A-- 2. vo1ILf,.L :Ili Li vt-r'fr(✓ cI1.-1CtiitL. At/10"> litni1 ..r)h1` .rrzic-Z.u..
IS THE PROJECT WITHIN 300 FT OF SLOPE r
S)GREATER THAN 14%: YES NO❑ SNOW LOAD: psf h-C1
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW/ ADDITION 0 ALTERATION 0 REPAIR❑ 1 OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) IMM Lit EX I) 1JJ f i lit ( n'4 a lL.r Ile 1r..,/
• IS USE: PRIMARY❑ SEASONAL,( NUMBER OF BEDROOMS <J I ivluMBER OF BATHROOMS a
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Perils]of Bldg)) NO❑ //
" DESCRIBE WORK In CU t �J 1. ✓
SQUARE FOOTAGE:(proposed) ��
1ST FLOOR ii-.I sq.ft. 2ND FLOOR‘31. sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK. sq.ft. COVERED DECK 2.EC•'>5 sq.ft. STORAGE sq.ft OTHER sq.ft
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached 0 Detached❑
MANUFACTLIR•E1311OWrEINFORM4.TION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
i/ MODEL EAR LENGTH
Vi1.51111 BEDROOMS BATHS SERIAL NU
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTING 14
PLUMBING IN STRUCTURE? YES NO 0 1 yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION//�D,RAINS PROPOSED? YES[ NOD EXISTING SQ.FT.
EXISTING BEDROOMS t_/ PROPOSED BEDROOMS I 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 if construction 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
COUNTY CODE 14.08.42)
X Ip - 19 — i3
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL �j� /,�,,� y�,,
PUBLIC HEALTH 1( t(4 (.vYIIW rT//l 0176(10(
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