HomeMy WebLinkAboutBLD2022-00555 Shop - BLD Application - 5/4/2022 MASON COUNTY COMMUNITY SERVICES Permit No:
PERM!!ASSISTANCE CENTER: EC E I�vj F-D
.BUILDING.PLANNING•PUBLIC HEALTH•FIRE MARSHAL �
40 615 W.Alder street,Shelton,WA 98584
Phone Shelton:(360)127-9670 exL 352-Fax(360)427-7798 Phone MAY - 4 2p22
8elfair.(360)275-4467•Phone Elma:(360)482-5269
BUILDING PERMIT APPLICAT W. Alder Street
PROPERTY OWNER FO TION: CONTRACTOR INFORMATION:
NAME: t^lL 0('L-- NAME: e 01 1
RA G DRESS: l MAILING ADDRESS: i
NG
CITY STATE: JA A ZIP: CITY: STATE: ZIP:
PHONE#1: 7 PHONE: CELL:
PHONE#2: EMAIL:
EMAIL: L&I REG# EXP.
PRIM4M CONTACT: OWNER 13 CONTRACTOR❑ OTHER❑
NAME .y I`tr�. J EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) GG� '7 ZONING
LEGAL DESCRIPTION(A/bbreviated W Sur DIS CT
SITE ADDRESS 910 i 1 t d P C e) /
D CTIONS T SITE DRESS (^ 1
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 1411. YESP NO❑ SNOW LOAD:�sf
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(K ADDITION❑ ALTEMTION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage Commercial Bldg,Etc.) SW
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(noleBldgl❑ YES(Part[s]of Bldg)❑ NO
DESCRIBE WORK
SQUARE FOOTAGE:(proposed)
I ST FLOOR sq.ft. 2ND FLOOR sq.& 3RD FLOOR sq.& BASEMENT sq.R
DECK sq.R COVERED DECK sq.R STORAGE sq.ft. OTHEROY00 sq.ft.
GARAGE sq.R Attached❑ Detached❑ CARPORT sq.fL 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❑ SEWER❑ / NEW❑ EXISTING❑
PLUMBING IN STRUCTURE? YES❑ NO I% Ifyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOPf. 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&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 WO K ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PE CA N OF 180 S OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42) `4
X �
Sign re (Must signed by the OWNER I to
DEPARTMENTAL REVIEW APPROVED QDATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT JTZ a 3-2 L
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
�Ur
/ ry
,} N
07/05/2022
APPROVED
MASON COUNTY DCD PLANNING ,^
• SeM RUEDV,40
i 81�r
RR5 Zoning i
Fror{Yard Setback.25'.
Side&Rear Yard Setbacks.Residential dwelling
and accessory structures is 20'.
OR 10%width of lot if not more than 100'wide
OR approved ADV
LRune
DI It
S
Rued '�
EH Setbacks
A.)Dralnfleld/Reserve requires 10'setback trom looting'oundaoons
B.)septic tank(s)requires5 setback from an tootingtouodauoor. l/
C.1 No IoundatbNPenmeler Drains within 30It down91ed-1 c1 11
Die nkeldd'Reserve area
D.)No Cut Bank($)(greater than 5k and over 45 degrees)within
Soft down gradient of DrainceidReserve area
EH APPROVED
Rhonda Thompson 07/26/2022
11211-G�rlm- Zig
'f 1
v l�� � � � ► �� (mac. ��` � ��
RECEIVED
MAY - 4 201Y
( 615 W. Alder Street
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