HomeMy WebLinkAboutBLD2023-00423 - BLD CD Environmental Health Review - 4/20/2023 MASON COUNTY COMMUNITY SERVICES Permit NO: 8
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inkPERMIT ASSISTANCE CENTER: v ��
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
815 W.Alder Street,Shelton,WA 98584 APR 19223 APR Z q
Phone Shelton:(360)427-g670 ed 352•Fax:(360)427-7788 Phmra 1023
Bellair:(360)275-4467•Phone Elms:(360)482-5268 615 W.Aide Str@ E1
ED
40 BUILDING PERMIT APPLICATION
FPROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: M
ie Manley NAME:Tim DevlinADDRESS: 1 3 t. a Slntlton r. MAILING ADDRESS: 136 91 Ve
dsport STATE:_ZIR 98 CITY:Olympla STATE:_ZIP:9360-677-2750 PHONE:206-714-1229 CELL:
9 2- - 7 iemanley@bellsouth.net Lad REO#S UNDCW896DP EXP. 05/0
PRIMARY CONTACT: OWNER p CONTRACTOR❑ OTHER❑
NAME EMAIL
MAILINGADDRESS CITY STATE_ ZIP
PHONE CELL
PARCEL INFORMATION:
PARCELNUMBER(12 Digit Number)22020-75-90090 ZONINGRR5
LEGAL DESCRIPTION(Abbreviated)LOT: A OF SO#629 S 4/139-, S 491193TYSHELTON
DISTRICT-
SITE ADDRESS250 E. BIG SKOOKUM RD.
DIRECTIONS TO SITE ADDRESS From DT Shelton, take WA-3N. Rlpht On E Agate Rd.
Right twice on E. Benson Loop Rd. Right on E. t5lq OKOOKUm Rd. Site is on the ripen.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NOD SNOW LOAD?s_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checkafl thatapply):.
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW El ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Rsodesce,Garage,p..,,i.,B1dg,Ere)Residence
IS USE: PRIMARY ❑' SEASONAL❑ NUMBER OF BEDROOMS' NUMBER OF BATHROOMS'
HEATED STRUCTURE? YES(Whole Bldg)❑' YES(Part(sI aJBldg)❑ NO❑
DESCRIBE WORK Cene°i01n^YeFtle1O u,.nmiot u•..evserva.m em.aw a imwe
SQUARE FOOTAGE: lPmvsad)
I ST FLOOR 296' sq.ft. (746+439+35= 1220 sf covered deck) ; sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK t'ke sq.ft. SJORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑. Detached❑ 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: -
SEWAGE/SEWER SOURCE: SEPTIC El SEWER❑ / NEW❑" EXISTING❑
PLUMBING IN STRUCTURE? YES ❑+ NO❑ If"yes,attach completed Water Adequacy Form
PERIMETER)FOUNDATION DRAINS PROPOSED? YES ❑+ NO EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 2 TOTAL BEDROOMS 2
OWNER acknowledges that submission of Inaccurate Information may result In a atop work order or permit revocation.AcluiaMedgement of such is by
signature below.I declare that I am the owner and I further declare that I am entitled to receive this remit and to do the wodr 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
remasenlalivejepresents that the information provided is accurate and grants employees of Mason County accpas to the above described property
and structure(s)for review and inspection. This peimNapplication becomes null 4 void ff work m authorized oomstruction is mot commenced within 1B0
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)
Signature of T ate
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL .;._
PUBLIC HEALTH Z..
manning aemactcs
Front:2F
PLN Approve Sides:20'
0 023 t 19D' pear:
'all setbacks measured from the farthest
M son County
Community Development r projectiodo
n of the building
Gavin Scouten _ I � 'sub ed to EH setbacks
All Changes Subject to Approval I \
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