HomeMy WebLinkAboutBLD2025-00613 - BLD CD Environmental Health Review - 5/19/2025 .), '*s•t, MASON COUNTY COMMUNITY SERVICES Permit No: B�20a5-ao413
t ,.:4- �k PERMIT ASSISTANCE CENTER RECEIVED
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t> roil ,i .BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL , \E C E I V E D
V' •0 615 W.Alder Street,Shelton,WA 98584
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���,r/^ s Phone Shelton:(36C)427-967C ext 352•Her:(360)427-7798 Phone MAY 1 9 202�
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�y Beak:(360)275-4467•Phone El'na:(360)492-5269
BUILDING PERMIT APPLICATION 615 W. Alder StreQt
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:jl Ark. ♦L1 r i k 6-((Hal (` 1 ,f NAME: Z.
MAILING ADDRESS: t 3D .., C pr ,pre) 1,,q4•;aMAILING ADDRESS:
CITY:-gel ce.r STATE:WA., ..V:i ,ct$ CITY: STATE: ZIP: y..G f-
PHONE#1: 36 C. -`131-ti't F(, PHONE: CELL: r`: IJU'� Xi
PHONE#2:3(/C) -3,40 -(,l°t t EMAIL: o O
EMAIL:yh A t•k A.)4.a�.,./�e_'l 9vs l (. Y r +) L&I REG# EXP. / / r-)
PRIMARY CONTACT: OWNER Ia CONTRACTOR❑ OTHER❑
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NAME 144. r "le- G- -A,ttle.L EMAIL
MAILING ADDRESS 1'I)S.Cyar,.) V i,e..,i ?..sit CITY RAAC.da.,- STATE tA r� ZIPRZs c---- rrlz
PHONE Ti2CI-i3t -44Tko CELL 36.O - 140 S-l'tl z
PARCEL INFORMATION: D
PARCEL NL'b1BER(12 Digit Number) :1 A R 2 1 "52.^'OC1) 1O ZONING ZAPS r--
LEGAL DESCRIPTION(Abbreviated)L.e 1--co T,..r�,e,•s R,.l1:t FIRE DISTRICT
SITE ADDRESS 130 E. (' 14 D tU 0 tQr� t2 . CITY t3 Ap,.,r
• DIRECTIONS TO SITE ADDRESS-4...,fio Nein C..tlt d i' kr, C.L•,-.)Lib►aUir U) 1z•Q Tom,i" -rt.,,,.*-
St 110 04., Ir._.: k.ct-
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO'® SNOW LOAD:A.S psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWLNG: (Chat all shot apply):
SALTWATER❑ LAKE 0 RIVER/CREEK 0 POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW ADDITION❑ ALTERATION❑ REPALR❑ OTHER ❑
USE OF STRUCTURE(Residua,Geroge,Comwocld.1dg Era)6/fir e
IS USE: PRIMARY❑ SEASONAL❑ NUMBER OF BEDROO-,S - ^ NUMBER OF BATH ROOM3•er"
HEATED STRUCTURE? YES(Wholealdg)❑ YES(Part[s]o f Bldg)❑ NO iii
DESCRIBE WORK_ALIZPLOOULI L..CL'Gt-
SQUARE FOOTAGE:(yroporee `J
li 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.R
GARAGE 6;.t00 sq.ft Attached❑ Detached A. CARPORT sq.R Attached❑ Detached,,
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
• MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER El / NEW 0 E:XISTIN(
PLUMBING IN STRUCTURE? YES❑ NOV, If yes,attach completed Water Adequacy orm
PH/FOUNDATION DRAINS PROPOSED? YES❑ OK EXISTING SQ.FT.
TOTAL
EXISTING BEDROOMS PROPOSED BEDROOMS 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 darters 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 nemasary parties.Indudng any easement holder or parties of interest regarding this prnler~The owner or legal
representative.represents that the information provided Is acrsrate and grants e;nployees of Mason County access to the above described property
and stnscaa(s)for review and Inspection.This permhJapplicatlon beoanes nut&void If work or authorized constnrcton is not commenced within 180
days or If const vetioer wok is suspended fora period of 180 days.
PROOF OF CONTINUATIONAF ORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION 0 .180 AYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
X ��1�- COUNTY CODE 14.08.42) 519/25
Signature of OWNER(Must be signed by the OWNER) t�Date
I nDEPLIRTMENTAL Rmgyv,:.*-"' iA1IRQVEDr'==44k,,.-.. ,_DINI$H)_i .A►TE.TAGS/NOTES/CONPrnONS,71!_
BUILDING DEPARTMENT
I PLANNING DEPARTMENT
FIRE MARSHAL PUBLIC HEALTH Cli\AAtak
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