HomeMy WebLinkAboutBLD2024-00070 - BLD CD Environmental Health Review - 1/18/2024 MASON COUNTY COMMUNITY SERVICES Permit No:Ild 2pz4- OQ77D
PERMIT ASSISTANCE CENTER: C C
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHALRECEIVED
615 W.Aid.,Steel.Shelton,WA 98584 -
Phone Shelf.:(360)427-9670 axt.352•Fear:(360)427-77gil Phan. 1AN t $ 2024
Belfa r (360)2754467•Phone Elms:(360)482-5269
BUILDING PERMIT APPLICATION 615 W.AIderStreet
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: Pam and Alan Ana NAME:Tyson Williams
MAILING ADDRESS:151 E.Twanoh Falls Dr. MAILING ADDRESS:PO Box 1756 IT --
CITY:Belfair STATE:WA yip:98528 CITY:Allyn STATE:WA ZIP:9
PHONE#1:360-580-6496 PHONE:360649-2509 CELL:
PHONE#2: EMAII.:
EMAIL:pamahol 973@gmail.com L&I REG#WILLLIDL8010Q
PRIMARY CONTACT: OWNER❑+ CONTRACrOREr OTHER❑ 'I .
NAME EMAIL
MAILING ADDRESS CITY STATE IP
PHONE CELL
PARCEL INFORMATION: AN 2 2 2 24
PARCEL NUMBER(12 Digit Number) 2 2221-52-0001 4 ZONING FIRS R
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 151 E.TWANOH FALLS DR. CITY Belfair
DIRECTIONS TO SITE ADDRESS North on N. 1st St.keep on northcliif Rd.Right on N. 13th St. North on E. BrockdalEa
Keep on E. McReavy Rd.Right on E. Dalby Rd. Right on E. State Hie 106:Right on E.Twarl Falls Dr.Site on Left
IS THE PROJECT WITHIN 300 FP OF SLOPE(S)GREATER THAN 14%: YES[] NO❑+ SNOW LOAD:25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Chedka/I rhataypty):
SALTWATER❑ LAKE ❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF ❑ STREAM❑
TYPE OF WORK: NEW❑E ADDITION E] ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE ttbudesre,Garage,Commemlataidg.&rc.)Residence
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(whoteifkW❑E YES(Panfsl oJ6iEg1 ❑ NO ❑
DESCRIBE WORK—sr""ONbnmw+c"wraa•,..mru.awwm....rmrmro.mmec.s
FOOTAGE: (pmpared„g gEmcY11 L oVIR
FLOOR 979 sq. ft. 2ND FLOOR 464 sq.ft. 3RD FLOOR sq.ft. B sq.ft.
DECK 24 sq.ft. COVERED DECK 12 sq.ft. STORAGE sq.ft. )_sq.ft.
GARAGE sq, ft. Attached❑ Detached❑ CARPORTZ_sq.ft. Attached❑ Detached❑E
NTtqVrAe+WFXLILIfflMZ INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL AS LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC❑+ SEWER❑ / NEW E❑ EXISTING❑
PLUMBING IN STRUCTURE? YES ❑E NO❑ Ifyes,adach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑+ NO[] EXISTING SQ.Fr.
EXISTING BEDROOMS 2 PROPOSED BEDROOMS O TOTAL BEDROOMS 2
OWNER acknowledges that submission of Inaccurate inksm allon may result in a slop 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 peimittapplication becomes null&void if"ro or authorized construction is not commenced Mhin 180
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT 18 BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
X, CO'g U�J'Y�ODE 14.08.42)
Signature o era �Data
DEPARTMENTAL REVIEW APPROVED DATE DENIED . DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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MASON COUNTY WA � i/-
COMMUNITY SERVICES >46dlha n
anudna rl.,�nnn.r�•�,an,M,u�uan¢n.<anmunirvR Wu
415 N 6'h Street,Bldg 8,Shelton WA 98584,
Shelton:(360)427-9670 ext 400 fi Belfair:(360)275- 467 ext 400 t• Elma:(360)482-5269 ext 400
FAX(360)427-7787
Application for Determination of Water Adequacy
Instructions
1. Complete Part 1. No determination can be made until Part 1 is fully completed.
2. Complete only the portion of Part 2 applying to the type of water connection utilized.
3. Submit completed application, With any required attachments for review.
4. An approved building site plan must accompany this application.
Part 1: Applicant/ Parcel Identification
Name on Applicant: Pam and Alan Aho Date: 1-18-24
Mailing Address: 151 E. Twanoh Falls Dr. Phone: 360-580-6496
Parcel Number: 22221-52-00014
Type of Water System Reason for Application
❑ Public/Community Water System (2 or more El Building permit V Id 207-4-=76
connections) ❑ Division of land:
❑ Individual water source(one connection), #of Parcels? SPL
❑ Well ❑ Boundary line adjustment
❑ Spring/surface water ❑ Other(explain)
❑ Other(explain)
❑ Replacement ol
emod please indicate name
If you have more than one residence connected of water system be ow If applicable-no
to this well, check the PubliclCommunity Water signature required)
System box. 3 V 1 A \
Part 2: Water Connection Information �y 1� N J�r
l Complete the section appropriate for the type of water connection being a uated:
Public Water System
Name of water system: Twanoh Falls Beach Club
Water Facility Inventory(WFI)Number:
(write"none"for two-party)
❑ 1 am the manager of this water system.The water system has been approved for_services.
There are presently connection(s)in use.This will be the connection.
❑ 1 am the manager of this system.This connection will be to upgrade or change the use of an existing
connection on this system(i.e.: recreational to full time). Please indicate on the following line the nature
of this change:
This water system is able and willing to provide water to this (these)connection(s)without exceeding
the limits of the water system or any limits set by state and local regulation.
Signature of Water System Manager Data 1-18-24
This form may be scanned and available for public view at www.co.mason.wa.us.
J.TH Fonnr\Drinking Water Revised I252018