HomeMy WebLinkAboutBLD2025-00609 - BLD CD Environmental Health Review - 5/20/2025 01.rt-lA:$ MASON COUNTY COMMUNITY SERVICES Permit No:
.47 Q t�I �j
PERMIT ASSISTANCE CENTER: R E C E I V E dJ
(07 �e# ell�R .BUILDING••PLANNING•PUBLIC HEALTH•FIRE MARSHAL
r • 615 W.Alder Street,Shelton,WA 98584
ti Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone hrf AY 1 9 2025
O - - y Belfair.(360)275-4467•Phone Elam:(360)482-5269
��� `'•" 615 W. Alder Skeet
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR LNFORMATION: rn •
NAME: i M(L 1 1-nc(.[1Ja,+ NAME:� I Q L 1111((�s l/l / V2-4 —
MAILING ADDRESS: Lei 2-U us) UGCyCup e.d4£' MAILING D SS: 13 L V
CITY:6 kA-l t7)Y1 STAT' :ltR zing: c s's-t Cfry:Cki I 1t STATE:'1 CELL:Wel ZIP: ' 1 k , C- . = 0
PHONE#2:
PHONE#1: ,(Ql7 2 Z�( EMAIL: D r� t�c1S 4 C. -m(t.t l,.c 3 n`l > Z
EMAIL: YYl(-LI cull•ha(1 le( eu 1.LDM I R,t REG# e DC G 1 8')8 EXP. /I 1/ Z- r-
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PRIMARY C NTACT: O R CONTRACTOR❑ OTHER 4'�
NAME T C SSC VIA G I It(1 Lt-�' � yL W CITYEMAIL
S I'�-¢C l' t'l SPATE 1kn1 t.�1 ZIP/�'I t I I Z
MAILING ADDRESS IA LD w LIZL J —�
PHONE ?��l�' ZZGI 0 UPI 8 CELL
PARCEL INFORMATION: r
PARCEL NUMBER(12 Digit Number) `��-per'`� 2 D U ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTR"ICT
SITE ADDRESS 2(-r Z ID l.v r)-2.-F q l•,� f . CITY -1 r1X ( 1-,=,n D
DIRECTIONS TO SITE ADDRESS 70 1T1 -<h.) R
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IS THE PROTECT WITH 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO❑ SNOW LOAD: psf O c t
-__II'\ '
IS PROPERTY WITHIN 200 FT OF lilt.FOLLOWING: (Cheek all shot apply):
SALTWAL1cR❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND SEASONAL RUNOFF❑ STREAM❑ p o
TYPE OF WORK: NEW F ADDITION❑ ALTERATION 0 REPAIR 0 OTHER ❑ cr
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc) pb Lt. Po
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROOMS I-Pot NUMBER OF BATHROOMS/) f 4—
HEATED STRUCTURE? YES(Miele Bldg)❑ YES(Part[r)ofBldg)❑ NO[W
DESCRIBE WORK
SQUARE FOOTAGE:(propared) .
1ST FLOOR sq.ft. 2ND FLOOR sq.R 3RD FLOOR sq.ft BASEMENT sq.ft
DECK sq.ft COVERED DECK sq.ft STORAGE sq.ft. OTHER sq.ft.
GARAGE'U t GP sq.ft Attached❑ Detached® CARPORT sq.ft Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF IILk FLOOR PLAN REQUIRED*
• MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
•
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 4 SEWER❑ / NEW 0 EXISTING
Zi!‘
PLUMBING IN STRUCTURE? YES❑ NO Al^ If yes,attach completed Wafer Adequacy Form
PERMETER/FOUNDATION DRAMS PROPOSED? YES❑ NO❑ EXISTING SQ.FT. •EXISTING BEDROOMS PROPOSED BEDROOMS p 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 I are 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.Tha owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County arsc.s to the above described property
and structure(s)for review and inspection,This permitlapplication becomes null&void if work or authorized construction is net commenced with!n 180
days or If construction watts 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
CO
DE CAUSE 1 E.42)E APPLICATION TO BE EXPIRED.(MASON
X__r__.___ 51 161 )2
Signature of OWNER(Must be signed by the OWNER) Date
-DEPARTMENTALlREVIEW; a-7;=5.il;ROVEDf;; DATE `•_D„ IQLED .DATE .'.TAGS/NOTESICONPIIIONS-
BUILDING DEPARTMENT
PLANNING DEPARTMENT MARSHAL
PUBLIC HEALTH (45K Ivixkmhb
P Sp_(
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$Lo _0 -" ' • EH APPROVED 1 / __
Rhonda Thompson 06/23/2025 1
EH Setbacks
A.) Drainheld/Aeserve requires f 0'setback from footing'foundations
B.)Septic tankis)requires 5'setback from all foonngloundations
C.)No foundatiorvPerimeter Crams within 30ft.downgradlent of '•
Drainfield/Reserve area
D.)No Cut Bankis)igreate•than Sit and over 45 degrees)within
•
5011,down gradient of DrainfielNReserve area •
E.)Use approved mitigation from section Cl.9 of the department of
ecology's'Cnterla For Sewage Works Desgn;when sewer
transport lines are%mhm 10ft of water supply Lees.
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