HomeMy WebLinkAboutBLD2025-00375 - BLD CD Environmental Health Review - 3/27/2025 � '144y, MASON COUNTY COMMUNITY SERVICES Permit No: PJ L O 2 02 c- 0031 Gj
7 ri; : PERMIT ASSISTANCE CENTER:
/4, 4. •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL RECEIVED
s R 615 W.Alder Street,Shelton,WA 98584
by 4 Phone Shelton:(360)427-9570 ext 352•Fax:(360)427-7798 Phone
2 -- ." y g.,: Belfair.(360)275-4467•Phone Elms:(360)482-5269 MAR Z ZOZ5
ab. dLoa
BUILDING PERMIT APPLICATION
PROPERTY� OWNER INFORMATION: CONTRACTOR INFORMATION:615 W. Alder Sit
D NAME: AV I D 1. 11-fA IA NAME: (-0jC4- F2EINCN
MAILING ADDRESS: 3 4/.1 D 1 1 0 5 1-a ur Y I O I MAILING ADDRESS: 9,6- Litt tot A) D
CITY: L. LL I W 4L)p STATE: W A ZIP:°I x Ci55 CITY:U!`=ct..c�Uf STATE: („Y ZIP: x s 5 7
PHONE#1: 15 3) 5 -0 4 i 0 PHONE:-i&) 5 3 I(8$CELL: .
PHONE#2: (Do(p) 1.4 -- ¢11-7 EMAIL:tiov ca;5"d gMciil, ccY
EMAIL: SC'Ae.kP, I0i d c):Ng 44 i.COM I-kIREG# 1)1MLC*12DJEXP. 3 /It)/.)
PRIMARY CONTACT: OWNER Lh CONTRACTOR❑ OTBERrn�1 -2
' c
NAME D(11uI1) I AI- EMAIL SPCtStAP_ 01 Q .CJm ern
MAILINGADDR).SS ?1 I 0 I\I US ,) 1 CITY Li LLI1A)...our STATE VA ZIP )c. ere')
PHONE (3.5.) 1 , rj -04 10 CELL `)Perna O �`
PARCEL INFORMATION: A
PARCEL NUMBER(12 Digit Number) ?))4 `--.")4-7 'i-
0 10 ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 34-6Xk M US Hu) i 101 CITY t-ILLi WAt)P
•
DIRECTIONS TO SITE ADDRESS
IS IliN,PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO((SNOW LOAD: csf •
IS PROPERTY WITHIN 200 FT OF 1HL FOLLOWING: (Checkalt that apply):
SALTWA f r.R if'LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW IFf ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) 6 Pr R.A GE.
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(ii'holesldg)❑ YES(Par:[s]ofBldg)❑ NOV—
DESCRIBE WORK CON STR t?`r 301 )C-6' &(44- -6
SQUARE FOOTAGE:(Proposed) .
1ST FLOOR 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 l O'i O sq.ft. Affached❑ Dvfarhed(Ie CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: • *4 COPIES OF tat FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEW). / NEW❑ EXISTING❑
PLUMBING IN S t ltUCTURE? YES❑ NO If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOR/ EXISTING SQ.Fr.
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.l 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
rep esentative,represents that the information provided is accurate and grants employees of Mason County a' es to the above described property
and strucure(s)for review and inspection.This perntJappiction becomes null&void if work or authorized construction is not commenced urthin 180
days or if construction work is suspended for a period of 180 days.
PROOF OF CONTINUATION W K ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION 8 AYS OF MORE WILL CAUSE THE APPLI ATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X%;-.:#.--fr---- --: 3 /7/035
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW r=s:;APPROVED: =DATE ;:=DENIED DATE`:'-TAGS/sIOTES/CO19DITTONS _
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL I
PUBLIC HEALTH il iz j1 a4,0414t5 40 ,
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