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Home My WebLink AboutBLD2025-00197 - BLD CD Environmental Health Review - 2/19/2025 01DI£BF&IA)FB&1111&1llEEPB MASON COUNTY P`""""" "�Iq7 COMMUNITY DEVELOPM1jK'.EIVED Permit Assistance Center,Building,Planning FEB 19 2025 BUILDING PERMIT APPLICATION i PROPERTY OWNER INFORMATION: CONTRA RIN NAME:+. — NAME:IwQeme MT caaeamn LW(Oaar:Consist Yananmr) MAILING ADDRESS:12m N ftd nOr MAILING ADDRESS:PO laa 1006 CITY:Nmaaan STATE:WA ZIP:beaS COY:aaawsm STATE:WA ZIP:M++%+ON PHONE#I:— PHONE CELL:—+—•> PHONE A2: EMAIL7;; a EMAIL:a4aa.01aeanaa LAI REGNIx1EONce.v+ EXP. 0N21 6 PRIMARYCONTACT: OWNER❑ CONTRACTOR I] OMERO NAME raxa...va..n.ala EMAIL a^6aNba+^ MAILING ADDRESS CTTY STATEZIP PHONE tw 1 CELL PARCEL INFORMATION: PARCELNUMBER(12 MgrNOal 40d+951m112 ZONING LEGAL DESCRIPTION(Abbreviad) 1d.Om.ran"TRI12 FIRE DISTRICT+a SITEADDRESSIM.F. Or CTTYNaaaaa+ DIRECTIONS TO SITE ADDRESS �^%ay^n laasa Nm 1N:Tun Lamlr.wa,rra.r Ra Tua Lam x Iaan daMo-,Tu:Larr N FM O,AadaYmRi[M ISTNEPROIECTW 3OOFTOFSLOPE(S)GREATERTHANI4Y.: YFSQi NO[] 0OWL0AD:_ysf ISPROPERTYWITINN200FTOFTHEFOLLOWIIG: t[NeetaoaaraNal: SALTWATER❑ LAKE Di R[M)CREEK O POND O WETLAND O SEASONAL RUNOFF❑ STREAM❑ TYPE OF WORK: NEW Di ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE lR,sw cwa..ca.aamaN*ea.)Rueaecnayaemmely ate auPpm WR abN eawg Swan Finaanw. ISUSE: PRIMARY❑ SEASONAL0 NUMBEROFBEDROOMS NUMBER OF BATHROOMS HEATED STRUCTURE+ YFS(WINeB4V❑ M(Panfa/alaey❑ NO Di DERCRIBE WORK�II reteMnB'aNb PmmtalLYSW Iai.e NNY.itla W an.un Nep NeMirybaue4ry 9FRaq Nvairo Fpvaiem. SQUARE FOOTAGE:(yAF„mj IST FLUOR sgft 2NDFL0OR_sq.R 3RDFLOOR Nit BASEMENT sq.R. DECK q fi. COVEREDDECK sq.R STORAGE sq.R. OTHER sq.R GARAGE sq.IL Almched[I DyWired❑ CARPORT N.It Afmdad0 Dewlied0 MANUFACTURED HOME INFORMATION: a4 COPIES OF THE FLOORPLAN REQUIRED- MAKE MODEL YEAR LENGTH WHOM BEDROOMS BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGESEWER SOURCE: SEPTIC SEWER❑ 1 NEWO+ EXISTINGQ PLUMBINGINSTRUCTURE? YES❑ NOD If a. .oh c.WIrfd Warn Adegmry Form PERIMETERIFOUNDATIONDRAMSPROPOSED? YES❑ NOO EXISTING SQ.FT. EXISTNG BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS MINER rysrls4ee TN aWmbebn a ncaale Mornandn mry molt in a ew w wan Is Ommit naaaaw.MknwNMOmment ormM bW erasure eeW.le.ln9l an IM worer ana l In.d.Net l an m4tlea to mcn ve ins PemiI ana to ao tM x asl Vaal I have MWnM ycmisa nn krm all tM—any Panm.adu aw any s4M1Nnenl noldtt a0anres ofruenaatt na,arrs,this Prole 11necuraa NOa tryrewrlArs naval that in. it vAN s)raavnai M8rmnY.kThn isI..,ad r yn.hervnn nultlm8 PvloolEe eilav m0n.or1.au1 days affwnawmwawumiP fwaPayA dIM cyra llCw nzeryd 9c m4natd➢ioNne'oS nodw m EremaarelrErueld P vtAoMPaN IY1 80 PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTITT'OF THIS PERMIT APPLICATION OF 1E0 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED,IYASON COUNTY MOE 14.MQ) XC�21�y�� 2/4/2025 +q1 N.'n'T syneNleq OWNER Must III elfnaN MINT OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE. DENIED DATE TAGS?NOTFSICONDTOONS BUILDING DEPARTMENT PLANNWG DEPARTMENT FIRE MAILRHAL PUBLIC FIEALTH DogWgn Ewebpe IM EBC0F7F1{9F94A7F-M3-17184736EE2B ENVIRONMENTAL MASON COUNTY HEALTH Shelton(360)427-9670 ext.352 DEPARTMENT OF COMMUNITY SERVICES BHfair(360)275-4467 Mason County Bldg.8,615 W.Alder Street Elma(360)482-S269 D Shelton,WA 98594 www.m.mason.wa.us REQUEST FOR BUILDING PERMIT EXPEDITIOA ECEIVED Date: 2/4/2025 YC Permit No.: (hU 2025- 001 -] FEB 19 2025 Name: Jeff Jarvis 615 W. Alder Street Mailing Address: 1260 N Potlach Or Hoodsport, WA 98548- 9553 Parcel Number: 42318-51-00112 Ffe 2 S 1260 N Potlach Or f Z�2y Site Address: R CF/yE0 Hoodsport, WA 98548- 9553 Request due to: ❑Medical Hardship ❑Fire Damage M Other Explanation of Hardship: See Geotechnical Repot and Emergency Letter. Hillside has failed, this is an active slide area Must include supporting documents.This may be a letter from a doctor,insurance claim report,report of fire damage from appropriate fire district representative or other relevant documentation. I(WE)understand the intention of this form to determine and document justification for expedition of a building permit to alter or reconstruct a structure on the above named property. Signature Owner/Agent: OFFICIAL USE ONLY Request: Ipproved (]Denied Date: Request denied for the following reasons: 12 Signature: Dlrectoraf CommunRy Services EH SETBACKS EH APPROVED a optic al lia,Sa lmmlbvan,Idataapn5 el s.ftla^a l,quim. .-alom zn lw4,ymuneauom grvobumriovpeam.r.,a,.imwim'm w'ew,m-y,tlwmwmamra o.aiama, OtR]iNYS ll, a�.w mmaraal Ill .,. a � F m03� ," tlTi ! I ,�q�, i P .g Jj 1= Q I N� �o�• �o al • ah F J • D ...Ogc 4 � a aizw a3 I m ¢ w voo kw c wg row wF- g v N Q m N w p r