HomeMy WebLinkAboutBLD2023-00606 - BLD CD Environmental Health Review - 8/1/2023 ,. 11*. MASON COUNTY COMMUNITY SERVICES
Permit No: /ZLO ��7_ 00�6/n
4 ` PERMIT ASSISTANCE CENTER: �t'
•BUILDING •PLANNING •PUBLIC HEALTH•FIRE MARSHAL
• ar
615 W.Alder Street,Shelton,WA 98584 C E►�/E D ENVIRONTAL
Phone Shelton:(360)427-9670 ext. 352•Fax:(360)427-7798 one
Belfair(360)275-4467• Phone Elma:(360)482-5269 HE TH
1854 , MAY 31 2023
BUILDING PERMIT 61hv !Pkreet 40
6
012013
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: RFC )L/6_0
NAME: hrok r14 I wSo jE Atn,IC, NAME: uttwl Q 0"114L (D,0/..l(A.,,,..MAILING ADDRESS: 70 5 T (Ar,ru.c Q„,.„. Rzr.,A MAILING ADDRESS: 0(1�c 7 0e,,,.yr,o_s� 11) 5 tom)
CITY: s}\,,,H,�,,, STATE: Up, ZIP: 1$5?'1 CITY: Q.4‘,1-.�I.r STATE: L/Ir ZIP: rI g5-)ei
PHONE#1: 3 6o- J )- 6O5S PHONE:3 to-So7-) 0z ( CELL:
PHONE#2: EMAIL : tv rr•,e,r C. O t1 61--c.o,c.c r-.
EMAIL: oaM¢.5____, c w5e(,0.UrA L&I REG# iU J\J E a c gLIO -\ EXP. C / )6 /2y
PRIMARY CONTACT: OWNER Et CONTRACTOR E OTHER❑
NAME r ,4re.0 (-SoJe,e)n•,\ EMAIL (Atr`t,5u3e.Av. ,)L6 WSLC,u,Or,e)
MAILING ADDRESS Jo 5 E C4,roc-A.j Qo.ns' C•0^A CITY S 1•,,1-,.. STATE U1 I ZIP ¶ 5?/1--/
PHONE CELL 360- 'lel- 6055
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) Z ZOZ,c)L 1 6)OJ 13 ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS-10 S (Any..r✓I i)v't r� I`oa.� CITY $k -1-uw
DIRECTIONS TO SITE ADDRESS J A rv,.A 9 e\ g-A, 4d Lc ;3 a,,,, 5 F u.,,r„_rv., f o.,..,A, g.,„i t 3 cA (,o b
at,, N itA
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO N
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER ❑ LAKE❑ RIVER/CREEK ❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑
TYPE OF WORK: NEW ki ADDITION ❑ ALTERATION ❑ REPAIR ❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) LAIAr.50,_
IS USE: PRIMARY ❑ SEASONAL❑ NUMBER OF BEDROOMS 0 NUMBER OF BATHROOMS 1 •
HEATED STRUCTURE? YES(Whole Bldg) ❑ YES (Part[sjofBldg) ❑ NO LSI
DESCRIBE WORK
SQUARE FOOTAGE: (propose+existing)
1ST FLOOR IOU! sq.ft. 2ND FLOOR F;`"1 sq. ft. 3RD FLOOR sq. ft. BASEMENT sq. ft.
DECK sq.ft. COVERED DECK sq. ft. STORAGE sq. ft. OTHER sq. ft.
GA GE //i iq. ft. Attached❑ Detached® CARPORT sq. ft. Attached C Detached❑
MA UFACTU ILO INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
7MODEL YEAR LENG
WIDTH BEDROOMS BATHS SERIAL
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC ❑ SEWER ❑ / NEW ❑ EXISTING gi
PLUMBING IN STRUCTURE? YES ® NO ❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES K NOD EXISTING SQ.FT.
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
•
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 pennit/application becomes null&void if work or authorized construction is not commenced within 180
days or if construction rk is suspended for a period of 180 days.
PROOF OF COp1T UATIO F WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT A. t TIO 0 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
X � / COUNTY CODE 14.08.42)
� S —3, -2lTr;3
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSIIAL ��••��
PUBLIC HEALTH 00 Yer(lv�� w/ttJ�.frcr? Q e
_ . -•pjL12 0 , -01�-&1XQ ..
1756E - 1 -
' s' '� Planning Setbacks
Front:25'
N' Side:20' I
NY ' Rear:20' .
si) 'all setbacks measured from the farthest !'
tfi •pb' i'()K-).
projection of the building !�
ys' \
xt,'4 'subject to EH setbacks
PLN Approved
so• r / 08/21/2023
S'' 9. I ZQ •Mason County Community Development
• Gavin Scouten
9• All Changes Subject to Approval
l_Y� Lie_ll
.. EH SETBACKS
41111 A)Dranheld/Reserve regunes t0•setback Iron footingffor ndatiens
B)Seb)ic tanks)regones 5•setback from an lootingnosndabons
C)No foundation/Oenmeter drains wrth.n 30•down gradient o)dpnf
reserve D)No cut(sk banks)(greater than 5'&over♦5 degrees)wrtnrn Sd• ,
Kdown.grad.ent ot el.ar..field/reserve area I
EH APPROVED
D.Am.,,... 08,2212023 I
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