HomeMy WebLinkAboutBLD2025-00705 - BLD CD Environmental Health Review - 6/9/2025 �' 4•1:1,\ MASON COUNTY COMMUNITY SERVICES Permit No: )\_O2.O25 " OU1 dej
, PERMIT ASSISTANCE CENTER:
ty •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL RECEIVED
1- s ig 615 W.Alder Street,Shelton,WA 98584
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may, +`^ D; Phone Shelton:(360J427-9670 ezt 352•Fax:(360J427:7798 Phone
\'1 y '�k Be,Yair.(360)275d467•Phone FJma:(360)482-5269 09 2025
BUILDING PERMIT APPLICATION
.• PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: 615 W.AidCf Street .
NAME: J 0 /'`yU fv DOe o&^ak LLc
MA . AD i ii'S. � c� O,�4 e G ADDRESS:323 2 Ck, ('f 91`-
CITY: - P STATE: ZIP: re/040 CITY:tAcey STATE:WA ZIP:98.305
PHONE#1: -*Q 6- c2.S I6 PHONE:36o 490 353 9 CELL:
PHONE#2: EMAIL:mow k& ltj /•f ou-t
EMAIL: !Ot f 4"9, . C OV •&T REG#+oo97810 EXP. Io/31/20ZS
PRIMARY CONTACT: OWNER❑ CONTRACTOR OTHER❑ VI Z
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NAME 4. e+'CI [ }4 EMAIL C'2
MAILING ADDRESS 3Z3Z-E k-e cf 51 CITY Lac U' STATE `-fA____ZIP 965O3 L -.
PHONE 3go-`190-3g34 CELL t--
PARCEL INFORMATION: `r
PARCEL NUMBER(12 Digit Number) "12011- 33-ooe0o ZONING a-CS
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS I d 21 ‘A., C i,�•••--P_H 20 S CITY Sit-e H0 tr
• DIRECTIONS TO SITE ADDRESS
IS 1'HL PROJECT WITBIiN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO Ig SNOW LOAD: esf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Cheek all therapply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND® SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION II REPAIR OTHER ❑
USE OF STRUCTURE(Re:fdeze.Garage,Commercial Bldg,Etc) R-Cf
IS USE: PRIMARY❑ SEASONAL NUMBER OF BEDROOMS L. NUMBER OF BATHROOMS Z..
HEATED STRUCTURE? YES(Whole Bldg❑ YES(Part[:]of Bldg)M NO❑
DESCRIBE WORK Re•..ode( vie/ RepA'(-•, hvci- Pet L.v,te-Is'•+-S, Sow a I..4'1-c,
• SQUARE FOOTAGE:(proposed) 6VIA, 56 /O1'; NI•r-IOL
1ST FLOOR IoSg sq.R 2NND FLOOR '$9 y sq.ft. 3RD FLOOR sq.ft. BASEMENT 3g0 sq.it
DECKS sq.I. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.( " GARAGE sq.ft... Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
/
,� }� MANUFACTURED HOME INFORMATION: • *4 COPIES OF tat,FLOOR PLAN REQUIRED*
�l' MAKE MODE YEAR LENGTH
WIDTH (---.- B 00MS BATHS SERIAL NUMBER
ENVIRONMENTAL IRALTH:
St WAGFJSEWER SOURCE: SEPTIC gj ShWEk❑ / NEW❑ EXISTING g
PLUMBING IN STRUCTURE? YES tg NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATIONDRAINS PROPOSED? YES❑ NOO EXISTING;SQ.FT.
•
EXISTING BEDROOMS Z PROPOSED BEDROOMS V TOTAL BEDROOMS
OWNER ackncwfedgs 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 lam entitled to receive this permit and to do the work as proposed.I have , .
obtained permission from an the necessary parties,including any easement holder or parties of interest regarding this projed.The owner or legal
representative,represent that the information provided Is accurate and grants employees cf Mason County ac-ecs to the above described property
and structure(s)for review and Inspection.This permit/application becomes null&void if work or authorized construction is not commenced within 180
days or if construction work is 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 WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42) � �
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X� e — /
R ewre of OWNER be signed by the OWNER) at
:`DEPARTMENTAL___ APPROVED:'==DATA DENIED DATE:".TAGSINOTES/COINDmoNS
BUIT DING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL y��- ,,,- �9y� �
PUBLIC HEALTH J V)f I 1 C " " -"-'
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" e °' () EH APPROVED
-' (D 5 " �-. 'Q� Rhonda Thompson 08/28/2025
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-., �1 cu 'c EH Setbacks
CD CD 3 A) DrainI ed Rocerve requires 4'setback from tootirlgloundations(WA12025-00075)
d .--: B.)Septic tank(s)requires 5'setback from all footinytotadations
C.)No fourdadon/Pedmeter Draws within 30ff.downgradlent of
Drainneld/Reae,ve area
D.)No Cut Bank(s)(greater than Viand over 45 degrees)within
l4 4 50n,doom gradient of Dralnf eldlReserve area
vV E.)Use approved mitigation from section C14)of the department of
W ecology''Criteria For Sewage Works Design'when sewer
transport Foes are within 10fl of water supply Noes.
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EH APPROVED
Permit Site Plan for 1021 W Carmen RD S Shelton WA Rhonda Thompson 08/28/2025
(1)
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Driveway
Septic tanks
A' 6'from house •
•
•
W Carmen CAR S •
•
•
Wetlands
EH Setbacks
NOTES: A.) grainfield/Reserve requires 4'setback from footing/foundations(WAI2025-00075)
B.)Septic tank(s)requires 5'setback from all footing/foundations
C.) No foundation/Perimeter Drains within 30ft,downgradient of
Drainfield/Reserve area
D.) No Cut Bank(s) (greater than 5ft and over 45 degrees)within
50ft,down gradient of Drainfield/Reserve area
E.) Use approved mitigation from section C1-9 of the department of
ecology's"Criteria For Sewage Works Design,"when sewer
transport lines are within 10ft of water supply lines.