HomeMy WebLinkAboutBLD2023-01175 - BLD CD Environmental Health Review - 10/5/2023 .4y� • h4;!b MASON COUNTY COMMUNITY SERVICES Permit No: . !(7
PERMIT ASSISTANCE CENTER: $ . -
5 •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
r �. '0 615 W.Alder Street,Shelton,WA 98584
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Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7796 Phone .)E P 2 V 2023
5 - - Belfair.(360)2754467•Phone Etna:(360)482-5269 • T
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BUILDING PERMIT APPLICATION 615 W. Alder Street Z
PROPERTY/OWNER INFORMATION: CONTRACTORTO� INFORMATION: _
NAME: /C� i)t 7 !� L, NAME:_ J� O
MAILIN _`�DRESS:aa.q!�-. 4L' 4/�,fie£ MAILING ADDRESS: z
CITY: 1/ STATE_L(/¢ Lipt. ...Owl* :\ STATE: ZIP: M
PHONE#1: ,3 .a3C.•-4.2 P:•NE: CELL: C) o U11�1U
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PHONE#2: EMAIL: kJ, ('n
EMAIL: T R T REG# EXP.// m o Z
P Y CONTA T: OffINERVG CONTRACTOR❑ OTHER❑ CIc...3
NAME aA,A 7 l/) EMAIL.
MAILING S Pa (%y: 7/ CITY/12)1.,_ TATEZ/24._ZIP —.' IA.— f "
•
PHONE CELL r
• PARCEL INFORMATION:
PARCFT NUIVBER(12 Digit Numbar)."C7- 52).,L7()f 76) ZONING
•
LEGAL DESCRIPTIO r(Abbreviated) J'r e"(. 9 l) FIRE DISTRICT
SITE ADDRESS ..", ). 4. - I CTTY I
IXT,I_CO IO_S IVE..A.1,DDFtF_SS _
4,4
IS THE PROJECT WITHIN 300 FT F SLOPE(S)GREATER 14%: YES❑ NO SNOW LOAD:�,,-Ds
. IS PROPERTY WiThIN 200 FT OF 111E FOLLOWING: (Chcckan that apply): ' 0
SALTWAlbR❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ .
TYPE OF WORK: NEW k ADDITION❑ ALT TION❑ REPAIR p OTHER 9
USE OF STRUCTURE(Residence,Garage,Comic cial Bldg;Eie) 3%b iiul 5 i
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS 2_
HEATED STRUCTURE? YES(whole Bldg)( YES T.—INK/nag)0 O❑
DESCRIBE WORK /� - , �'r1 l JL
SQUARE FrOO/ A d OT E:(propose
/. /1ST FLOOR / q.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ti
DECK __sq.R COVERED DECK sq.ft STORAGE sq.ft. OTHER sq.ft
GARAGE sq.ft.Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION:� �1 *4/COPIES OF THE FLOOR PLAN REQUIRED*
MAKE (144YA I J MODEL.r+hY//J /TLC t4• YEAR z..,?L" LENGTH J
WIDTH c.Q 7 BEDROOMS BATHS SERIAL NUMBER /(J//�
ENVIRONMENTAL HEALTH:
SEW AGE/SEWER SOURCE: SEPTIC tg SEWER❑ / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES Al, NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO[ EXISTING SQ.FT.
6EXISTING BEDROOMS PROPOSED BEDROOMS A ' i. TOTAL BEDROOMS
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revoea5on.Acknovrledg t of suds is by
signature below.I declare that I am the owner and I further declare that I am entitled to receive this petrel and to do the work as proposed.I have _
obtained permission from at the necessary parties,inducting any easement holder or parties of interest regarding this proje 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 contra cton is not commenced within 180
days or if constriction work is suspended fora 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
•--7,— COUNTY CODE 14.08.42)
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Signature of OWNER(Must be sr ed a OWNER) D
DEPAR MENTAL REVIEW: : :i'APPROVED'==DATE` DEI<]lD_ ;:DATE....--'TAGSINOTES/CONDITIONS__
BOLDING DEPARTMENT
PLANNING DEPARTMENT I .
FIRE MARSHAL (�y `
PUBLIC HEALTH ,n 'A1 w1',3 _ _�/ - ••� -' i
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�,_. 4?aU • F1QGLU/1'1 - EH APPROVED
`.: .Rhonda Thompson 11/20/2023
TOPOGRAP•H•Y PROFILE: • aft EH Setbacks
A.) Drainfield'Reserve requires 10'setback from footing/foundations
B.)Septic tank(s)requires 5'setback from all footing/foundations
C.)No foundation/Perimeter Drains within 30ft,downgradient of
Drainfield/Reserve area
D.)No Cut Bank(s)(greater than 5ft and over 45 degrees)within
50ft,down gradient of Drainfield/Reserve area
Direction:: Scale: Approval: forofiice use
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Building Permit number: 6 ,Cl 1 75" RtoN Mil 11 /%aC Building:
Owner/Applicant:-ERffZbl L-A j—0.-- Lf: t K )2M Lbate of Planning:
J/lg./6 ad Thg tappiicatlon: Env. Health:
Parcel Number: 3 i q o 7-- 50 -00 i 7(9 or RD, 9/ "
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