HomeMy WebLinkAboutBLD2023-00279 - BLD CD Environmental Health Review - 3/9/2023 �J`. ric�� •'''''A `, MASON COUNTY COMMUNITY SERVICES Permit No: ' 1G1 2D20�j - C 19
PERMIT ASSISTANCE CENTER:
.J (' I - , Z •BUILDING •PLANNING•PUBLIC HEALTH•FIRE MARSHAL R E C E I V Eb
• p 615 W.Alder Street,Shelton,WA 98584
y f Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
7�Y ^dye' Belfair(360)275-4467•Phone Elma:(360)482-5269 MAR 0 9 2023 n
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BUILDING PERMIT APPLICATION 615 W. Alder St r `fit
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: `Sill
NAME: ptnAt-ve 60ldtRI NAME: NW ar.gQh Qay)Svi1C110r„ Z
MAILING ADDRESS: p.O. BOX $(2 MAILING ADDRESS: DA N.114kv).1(to r 124
CITY: 1=111v\v-) STATE: V\Jr1 ZIP: .614 2� v1A 1 CITY: C1ie' liS STATE: \A ZIP: 4M
PHONE#1: PHONE:-- ho.14D-034' CELL:
PHONE#2: EMAIL : re.19eCc4 Inw Tree nIn owl eS•v1e-1- r"
EMAIL: L&I REG#NwC�pcL�C92Zc,c EXP. 1l /ZS /202.4
PRIMARY CONTACT: OWNER ❑ CONTRACTOR a OTHER 0
NAME h-00 CCA - NW <aYpey Conic\ uc ho i-- EMAIL ire\Pe C(a@ hw X-'•�:2v-L,oW2C. ►n€4
MAILING ADDRESS Zbl N•-t14 v,--:t Item— �,A CITY Cie 1nA li S STATE W ZIP 1 VS-Z
PHONE -2)b0•-I4D• b.L{-c CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 2211C) •32_ - 10 0 7 ? ZONING
LEGAL DESCRIPTION(Abbreviated) SI/Z S 1/2_ NI/2_ SW \AI OF }LAN lo-t 2 FIRE DISTRICT
SITE ADDRESS -131 E..V1laSOV1 1:3 1covi k2--t1 CITY C-1rA fin ieW
DIRECTIONS TO SITE ADDRESS 1 4Vh VI 01,11" Ovrt'U WI9-3 N/E pig S+; -tU`Ch I-p
ovck o \ 10 cc►-- QV)s01^ P-d, e
IS THE PROJECT WITHIN 300 FT OF SLOPE(S) GREATER THAN 14%: YES❑ NO Er SNOW LOAD: Zr)psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE ❑ RIVER/CREEK ❑ POND ❑ WETLAND❑ SEASONAL RUNOFF ❑ STREAM 0
TYPE OF WORK: NEW Er ADDITION ❑ ALTERATION ❑ REPAIR ❑ OTHER ❑- IR 1-)IACewi-evt
USE OF STRUCTURE(Residence, Garage,Commercial Bldg,Etc.) \r4siolkyi CQ
IS USE: PRIMARY Er SEASONAL ❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES (Whole Bldg) a YES (Part[s]of Bldg) ❑ NO ❑
DESCRIBE WORK IONWRV)''c A W1Ah.UAACiVore_ (i I'10vytg
SOUARE FOOTAGE: (proposed)
1ST FLOOR 1.67 0 sq.ft. 2ND FLOOR sq. ft. 3RD FLOOR sq. ft. BASEMENT sq. ft.
DECK 2- sq. ft. COVERED DECK sq. ft. STORAGE sq. ft. OTHER sq. ft.
GARAGE sq. ft. Attached❑ Detached 0 CARPORT sq. ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE \ QtAi 0 0 A MODEL 29 4 O3 F\ YEAR 2027 LENGTH 4-0
WIDTH Zb 66 BEDROOMS BATHS 2_ SERIAL NUMBER i'p' Q ass 1 i y1Q of
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC [ " SEWER ❑ / NEW ❑ EXISTING [K.
PLUMBING IN STRUCTURE? YES [Y NO ❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NO Dv EXISTING SQ.FT.
EXISTING BEDROOMS 95 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
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 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)
X /w- ,,,,c I'2-02:3
Signature of OWN (Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH ' I- q 110(z j Cr S a- 41
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