HomeMy WebLinkAboutBLD2025-00366 - BLD CD Environmental Health Review - 3/23/2025 a''' - .—. MASON COUNTY COMMUNITY SERVICES t, /1j1'?�(DID
PERMIT ASSISTANCE CENTER: Pie!mt , IJC� lV
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•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
615 W.Alder Street.Shelon,WA t)8584
Phone Shelton:(360)427-9670 ext.352•Fax(360)427-7798 Phone MAR 25 2025
Belfar(360)275-4467•Phone Elma:(360)482-5269
'' Alder Street
BUILDING PERMIT APPLIGAto141
PROPERTY OWNERINFORMATION: CONTRACTORINFORMAT�NVIRON!MENTAL
NAME: ICk&11 C 4c�sev" NAME: 1l H �1LT H
MAILING ADDRESS: lVS'O a f(v4) Kci- MAILING ADDRESS:
CITY_S ale 1 CDii. STATE: ji.) ZIP:?0s1 CITY: STATE: ZIP:
PHONE#I: 3Co -78 9' PHONE: CELL:
PHONE#2: EMAIL:
EMAIL: 04.(Ke jbaS er g0P5 C tlt•Co Ml&cI REG# EXP. / /_ �AN
PRIMARY C.ONT C7 OWNERjA CONTRACTOR OTHER m,„ ��
NAME k fie.. `cA5�r EMAIL N1t L CLS t?'r8O�y malt. �`
MAILING ADDRESS 1({S ) C, ./`�a((ula� IZd. CITY S(t-2_J O STATE (tt A ZIP �/gSBf Q f
PHONE 360*- 7g9.ico CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) d—<f-® 1 1. 2 ( C)f//
ZONING
LEGAL DESCRIPTION(Abbreviated) L 0 C,� S 0? A- Igticy-rp j"'n 11E.Sut'Z�el'27/E6Y
: COITE ADDRESSSZ 4O 14 o ' COCIT (�2jA.
DIRECTIONS TO SITE DRESS t •
A. 0 c CO R / �71• GAl r j 5 A n-e 6 t-
IS THE PROJECT WITHIN 300 FT OF/SLOPE(S)GREATER THAN 14%: YES❑ NO
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❑ ADDITION$ ALT RATION REPAIR OTHER ❑
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Etc.) CQ f'9(�/tt
IS USE: PRIMARY pif SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? S(Whole Bldg)❑ YES(Part(s)ofBldg)❑ NO❑
DESCRIBE WORK Vt..Id(ki (L ' x a.) � co-t-oft to EA 15/171(.5' sI.rtLC-Z`ur-e-
SOUARE FOOTAGE:(propose+existing)
1ST FLOOR36 g sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT 30 S sq.ft. Attached 4 Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE II` /A MODEL YEAR LENGTH
WIDTH ` BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC sel, SEWER❑ / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES❑ NO, If yes.attach completed Water Adequacy Form v�
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO EXISTING SQ.FT./l o
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 1 am entitled to receive this permit and to do the work as proposed.I have
obtained permission(rum all the necessary parties,including any easement holder or parties of interest regarding this project. The owlet 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 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
xt. ..1 4 21.11D Ob i COUNTY CODE 14.08.42)
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL ,(w� ,/
PUBLIC HEALTH �P(' S/1/IS ( U'/' I Qd,b0J/
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