HomeMy WebLinkAboutBLD2025-00376 - BLD CD Environmental Health Review - 3/26/2025- ' n 'leek
Permit No:B 11 026-e03V
_ MASON COUNTY RECEIVED
COMMUNITY DEVELOPMENT MAR 2 7 2025
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION 615 W. Alder Sleet
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: . rn
NAME:Deborah Wallace NAME: Z
MAILING ADDRESS:PO Box 773 MAILLNG ADDRESS:
CITY: Leona Valley STATE:CA ZIP:93551 CITY: STATE: ZIP:
PHONE#l:661-789-7718(Deborah) PHONE: CELL:
PHONE#2:661-789-7716(Jack) EMAIL,: rn 0
EMAIL:coolwater@dslextreme.com L&I REG# EXP.—/—/— D Z
PRIMARY CONTACT: OWNER 0 CONTRACTOR❑ OTHER❑ -,,i 7
NAME Williams Architecture(applicant,please copy owner) EMAIL nidc@williams-archltecture.com l rn
MAULING ADDRESS PO Box 102 CITY Shelton STATE WA zip98584
PHONE 3604260511 CELL Z
PARCEL INFORMATION: D
PARCEL NUMBER(12 Digit Number) 22019-75-00030 ZONING RR5 r
LEGAL DESCRIPTION(Abbreviated)_._... FIRE DISTRICT �Af�
SITE ADDRESS 810 E.Old Farm Rd. CITY Shelton 7 c
DIRECTIONS TO SITE ADDRESS From DT Shelton,Take WA-3 N.Right on E.Agate Rd.Right on E.Old Farm Rd. 1 9�
Site Is on the left �C j
IS THE PROJECT WITHLN 300 FT OF SLOPE(S)GREATER THAN 14%: YES0 NO❑ SNOW LOAD:25 psf �. t-i
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): trO f
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW❑ ADDITION 0 ALTERATION 2] REPAIR❑ OTHER 0
USE OF STRUCTURE(Rerideace.Garage.Comity ial Bldg.Fes)Residence
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2.5
HEATED STRUCTURE? YES(WhoteStdg)❑ YES(Pmr/s/ofBUS/0 NO 0
DESCRIBE WORK Partial demo of existing building for purpose of constructing new entry and additions for new stairs. '�e
SOUARE FOOTAGE;(proposed. 0 at net new
1ST FLOOR s'"sas*" . 2ND FLOOR sq.R 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK 70 st new sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.R. Attached 0 Detached 0 CARPORT sq.ft. Attached 0 Detached 0
I 'F RMATI N: •4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL AR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER❑ / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO❑ If yes.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT. 1400
EXISTING BEDROOMS 2 __„_, PROPOSED BEDROOMS ' TOTAL BEDROOMS?___ _
OWNER acknoWedges that submission of Inaccurate information may result In a stop work order or permit revocadon.AdmdiA•dpement otsuch 4 by
signature below.I declare Net tan the owner and Mintier declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from as the necessary parties.including any easement holder or prase of interest regarding this project.The owner or legal
rspressntadvs,represents t et the ktonnstlon provided U ackxrats and Drente employees of Mason Carey access to the above described property
and struchrs(s)for review and inspection. This perm*l.ppfcaion becomes nut&void II walk or authorized construction Is not commenced wt tin 180
days or If corwbudlon 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 160 DAYS OF MORE WILL CAUSE THE APPUCATION TO BE EXPIRED.(MASON
COUNTY CODE 14.0E42) ,C.,
x�� 5/2 a �a
Signarixe of Ape pals
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL , _'J.,
PUBLIC HEALTH 5�11Y�1j (010/.' c _ !
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: �a D rs=CgW�A ;11 1 1id• DEBORAH WALLACE 7b'1 90 1.-/i 'O E ,�, 1 � MASON COUNTY,WASNINGTON $1 iih ; yp $Ea j. i 3
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