HomeMy WebLinkAboutBLD2025-00236 - BLD CD Environmental Health Review - 5/19/2025 -. \ MASON COUNTY Permit No:
RE
1 COMMUNITY DEVELOPMENT RECEIVED
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�� FEB 2 7 2025
�,' ;,r Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION 615 W. . . Skeet
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: or /t 130.r: NAME: Self rn
MAIL A SS: 0 MAILING ADDRESS: Z
CITY: e1 r STATE: A zF:9$5 Z?.e CITY: STATE: ZIP: 4) ��
PHONE#1:0�) n 3 I ZZ 8t4 PHONE: CELL: 'f
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PHONE#2: EMAIL: 6
EMAIL: t L&I REG# EXP._I s/ �O�s m ")
PRIMARY CONTACT: OWNER CONTRACTOR 0 OTHER 0 0 Z
NAME [7(•'€ (3Qrtan EMAIL
MAILING ADDRES� V P CITY STATE ZIP "I K
PHONE CELL = rn
PARCEL INFORMATION: Z
PARCEL NLINBER(12 Digit Number) Z Z Z2-4 15 6100 q Z ZONINGS
LEGAL DESCRIPTION(Abbreviated) FIRE DI CT N•PtAsov I.-
SITE ADDRESS 00 e Coon • r CITY Qe& l i'r
•IRECT ONS T!SITE ADDRESS (fit a -Turn t.'1 `Ta ■ .t EMIL Dr
I on : :rss c - . A a( 1
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14•/.: YESB NON( SNOW L s AD: ,.psf � S
IS PROPERTY WITHIN 2 FT OF THE FOLLOWING: (Check all that applry
SALTWATER 0 LAKE RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEWX ADDITION 0 ALTERATION REP /R..0.�yOTTH,�ER 0` n A^
USE OF STRUCTURE(Residence.Garage.Cum.e'cia/Bldg.Etc.) 6 F 3 f Y t t Ir7(..l7LU 6R�/4C'7ir
IS USE: PRIMARY It SEASONAL 0 NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE?_ YES rt'7.oeetdgl dole
(P (r)o!B ❑ NO❑ �)�
DESCRIBE WORK I.-0+- afire L de e�W J?uq ,Wa'ki J cc1`& aj
SOUARE F TAGE:upeP��ed1 ee kk^05 6 F R J
1ST FLOOR sq.ft. 2ND FLOOR I t0 13 sq.ft. 3RD FLOORVT1,sq.ft. BASEMENT sq.ft.
DECK sq ft. COVERED DECK,3Z3 sq.ft. STORAGE .- sq.ft. OTHER sq.ft.
GARAGI sq.ft. Attached® Detached 0 CARPORT l" sq.ft. Attached 0 Detached 0
MANUFACCU ED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED'
N
A. MODEL YEAR LENGTH
MAKE
WIDTH BEDROOMS BATHS SERIAL NUMBER
1
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEW 0 EXISTING
PLUMBING IN STRUCTURE? YE NO❑ byes.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES NO❑ EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 2. TOTAL BEDROOMS 7_
OWNER acknowledges that submission of inaccurate Monnabon may result in a stop work order or permit revocation.Acknowledgement of such is by
signetae below.I dedsre that I am the owner end I Anther declare that I am entitled to receive live permit and to do the work as proposed.I have
obtained permission from as the necessary parties,inducing any easement holder or parties of interest regarding this protect.The owner or legal
representative.represents that the information provided b accurate and grants employees of Mason County access to the above described property
and structure(s)for review end Inspection.This panne/application becomes nue&void f work or authorized construction is not commenced within 180
days or f construction work Is suspended for a period of 180 days.
PROOF OF CONTINU •N OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT • • OF 180 DAYS OF MORE WILL CAUSE THE Art LICA ON TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
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Signature of OWNER(Must be sinned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL •
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PUBLIC HEALTH 1�2 51Arl/r Cy'�'( r/�,1/pt S R
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Seleode , WA 18528
131...pRoR5-oo23(0
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Fwki.re $ari[-Pt r
'`°" c, EH Setbacks
--- .1. A.)Drainneld•Reseive requires 10'setback from tooting/foundations
3 B.)Septic tank(s)requires 5'setback from all foctingloundatons
C.)No toundatioNperimeter Drains within 30ft.downgradenl of
�' Drainfield.Reserve area
,p D.)No Cut Bank(s)(greater than 5ft and ever 45 degrees)within
500,down gradient of DrainfieldiReserve area
S.)Use approved mitigation from section C1.9 of the department of
o ecology's-Criteria For Sewage Works Design-when sewer
transport lines are within 100 of water supply Ines.
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EH APPROVED
Rhonda Thompson 05/19/2025
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