HomeMy WebLinkAboutBLD2025-00760 - BLD CD Environmental Health Review - 6/26/2025 ,
MASON COUNTY Permit No: i3L �Q -Q(�W)
'' COMMUNITY DEVELOPMENT RECEwr_
JUN 2 4 2025
''. Permit Assistance Center, Building,Planning
BUILDING PERMIT APPLICATION 615 W.Alder Scree /5<(`0
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: 3
NAME:Tad 8 Jessica Smith NAME: Tn 5 t4 t reO Z
MAILING ADDRESS:1540 E.Shelton Springs Rd C MAILING ADDRESS: `",n 5c5
CITY:°holton STATE:WA ZIP:9B880 CITY:"'°nest"' STATE ZIP:'98°"-
PHONE#1:364'4824558 PHONE:8G4-J98.8ee1' CELL:340°--Na '-Yt.7
PHONE#2: EMAIL. �!
EMAIL: L&I REG#HEeeEt+ 6 ��5►X!P 02 13/26 ,�
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PRIMARY CONTACT: +
OWNER 1gam OTHER +� f"�
NAME TA-13 SM 1'T�I EMAIL /.i-SM lr�'2s7106-MA-lL.4.,, 3 `��
MAILING ADDRESS /_i 10 tr r34e-I Anti S iw.7J / J CITY 4 i/r� STATE u/et ZIP 9kr,/ I. rn
PHONE A P- 'fin i— VT S"., CELL r Z
PARCEL INFORMATION: D
PARCEL NUMBER(I2 Digit Number) 319°4-14-9°02o ZONING r
LEGAL DESCRIPTION(Abbreviated) Lot 2 of SP#3157 AFe2189532 PTN of SE NE FIRE DISTRICT
SITE ADDRESS 201 E Elws Rd CITY Shelton
DIRECTIONS TO SITE ADDRESS
WA-3/S Olympic Hwy S.left onto SE Craig Rd.left onto SE Cole Rd.left onto SE Edo Rd
1S THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO 0 SNOW LOAD:.25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all rfarapplyr:
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence.Garage.Commercial Bldg,Ere)New 4 Bedroom SFR
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS 4 NUMBER OF BATHROOMS4
HEATED STRUCTURE? YES IN7raleBfdgt❑v YES(Parris'of 0 NO 0
DESCRIBE WORK New SFR
SQUARE FOOTAGE:rn,,,p0se4/
1ST FLOOR 2811 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.It. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER 5i° sq.fi.
GARAGE 1060 sq.ft. A/racked 0 Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION:
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATIIS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER❑ / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE'? YES 0 NO 0 lies.attach completed Water Adequacy form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOO EXISTING SQ.FT.
EXISTING BEDROOMS° PROPOSED BEDROOMS 4 l./ TOTAL BEDROOMS 4 "--------
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 ant 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
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 d work or authorized construction Is not commenced within 180
days or if construction work is suspended fora 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
COUNTY CODE 14.08.42)
X s - 2Z— Z..D27
Sign ure of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
r PUBLIC HEALTH t llc(i(tC CAM4, 7AAJZ C,A.CA
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