HomeMy WebLinkAboutBLD2025-00790 - BLD CD Environmental Health Review - 7/7/2025 er CO�r
♦/ MASON COUNTY COMMUNITY SERVICES No:ellr PERMIT ASSISTANCE CENTER: Permit : 16U)a.U5-OM 90
T!� •BUILDING•PLANNING•PUBLIC HEALTH.FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584 E N •
. 010. Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone H HALT ' (
Belfair:(360)275-4467•Phone Elma:(360)482-5269
a
PERMIT APPLICATION 615 W. Al. .r StJeet� O
BUILDINGUL i 2025
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: RFCF,V ,
NAME: S YIY\a WAS YY(qV NAME: yyto, C4nS\Y\SCt\W
MAILING ADDRESS: ,',330 jkA1.1( 'QX ' '4 WtSt MAILING ADDRESS: c3\12' MUM IMY\Q01( V.C\
CITY: ?44a\Y STATE: ZIP: CITY: S VQC L STATE:\Mt ZIP:G*52460
PHONE#1: 3(ap-(020-(Pb3 PHONE: 3100 ~1.5\• 7,otELL:V)t' 7,(000
PHONE#2: EMAIL: h,ttm\YWt10Y1CdQ y'h \,(Wft
EMAIL: L&1 REG 11 ,VyCC,1``lc-),1 a EXP.12._/Min
PRIMARY CONTACT: OWNER ❑ CONTRACTOR N OTHER n.
NAME \,-Y1YAY\ --- 0'M EMAIL \U OW\S1\UC t0Y1C0 OtiMt\ WW1
MAILING ADDRESS c\115 N1W V\0 ‘12-'e'( V-( CITY v.- STATE, ( ft ZIP Oa(.)
PHONE 3(oV- —11 } Z(1 U\) CELL
PARCEL INFORMATION:PARCEL NUMBER(12 Digit Number) iZ3 co--O b0` 0 0°0O ZONING
LEGAL DESCRIPTION (Abbreviated) FIRE DISTRICT
SITE ADDRESS '2j()Q M E 1 l ere Y \)J\-{ W.t -t- CITY c?)\ \ Q 1 Y f v t°(
DIRECTIONS TO SITE ADDRESS 'TO A(1 l k'O Y> -\\qe V W�l..\ t a uk \I 7 VA t Ve —
,a 5 Ova U v \DO.. .
IS THE PROJECT WITHIN 300 F F OF SLOPE(S)GREATER THAN 14%: YESn NO
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check alf that apply):
SALTWATER n LAKEVt RIVER/CREEK n POND❑ WETLAND n SEASONAL RUNOFF n STREAM ❑
TYPE OF WORK: NEW f j ADDITION n ALTERATION n REPAIR �n OTHER n
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) O\�i-CQ�\ tc1,2\�`�-
q1S USE: PRIMARY ❑ SEASONAL n NUMBER OF BEDROOMS NUMBER OF BATHROOMS -S
ri HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Pan/s)of Bldg) , NO ❑
j [-
DESCRIBE WORK eQ\C`Q QNASt\Y\G\ C\'.C (--
SQUARE FOOTAGE: (propose t existing) 1
1ST FLOOR sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq. ft. BASEMENT sq. ft. 1./
E• FLOORg New
DECK /s`IA sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq. ft.
1/40
GARAGE sq. ft. Attached❑ Detached LJ CARPORT sq. ft. Attached❑ Detached U
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* �'
MAKE _ MOI)F.I. YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL.NUMBER
. I
ENVIRONMENTAL HEALTH:
4
SEWAGE/SEWER SOURCE: SEPTI(;etc SEWER U / NEW U EXISTING
PLUMBING IN STRUCTURE? YES ❑ Nt If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED'? YES❑ NO EXISTING SQ.FT.
i
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 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
ranrocontativn ranraconle that tha infnrmation nrnvirlari is am into Anil nrantc omnlnvaac of Macon Rn mtv arras.In Iha ahn,ja rlacrr,harl nrnnnrtv
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SIONS:
WESTERMANN RESIDENCE
--'�' 300 NE TIGER WAY W
-- - BELFAIR,WA 98528 c ; :...a
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N I _ _..--� PLOT PLAN 1