HomeMy WebLinkAboutBLD2023-00059 - BLD CD Environmental Health Review - 1/18/2023 L tis(sFeLloo
MASON COUNTY COMMUNITY SERVICES Permit No:��d2023 ' �bb� 1
��c PERMIT ASSISTANCE CENTER:
'` •BUILDING•PLANNING •PUBLIC HEALTH•FIRE MARSHAL
Mir - 615 W.Alder Street,Shelton,WA 98584
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�y Phone Shelton:(360)427-9670 ext. 352•Fax:(360)427-7798 Phone RECEIVED
Beifair:(360)275-4467•Phone Elma:(360)482-5269
.i , JAN 18 2023
BUILDING PERMIT APPLICATION 5
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:Alder Street
NAME:Accurate Development,Inc. NAME:SouthShore Construction
MAILING ADDRESS:PO Box 76 MAILING ADDRESS:PO Box 963
CITY:Allyn STATE:WA ZiP:98524 CITY:Belfair STATE:WA ZIP:98528
PHONE#1:206-200-3325 PHONE: CELL: 36049-1342
PHONE#2: EMAIL ruthshore@q.com
EMAIL:tom@thomaswolter.com L&I REG#848-345-01 EXP. /_/__
PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER 0
NAME Both Please EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION: - 033 SF hf NI�,�EA i
PARCEL NUMBER(12 Digit Number) 32034 50-00 ZONINGEALTL
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 161 SE Picidilly Drive CITY Shelton
DIRECTIONS TO SITE ADDRESS Arcadia to Binns Swigger Loop to Picidilly. Approx 6th home on Left
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO 0 SNOW LOAD:30 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE 0 RIVER/CREEK❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM 0
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION ❑ REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)Residence
1S USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole Bldg) 0 YES (Part[s]of Bldg)❑ NO 0
DESCRIBE WORK Decommission existing old Mfg Home and install new Mfg Home
SQUARE FOOTAGE_ (proposed)
1ST FLOOR 1296 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. ft.
GARAGE sq. ft. Attached❑ Detached❑ CARPORT sq. ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKEChampion MODELDreamworka YEAR2023 LENGTH 48
WIDTH 26.8 BEDROOMS 2 BATI-IS 2 SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER❑ / NEW 0 EXISTING 0
PLUMBING TN STRUCTURE? YES 0 NO❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT. 1100
EXISTING BEDROOMS 2 PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER acknowledges Mat submission of leacaaats Information may restrain a stop work ceder or pemit revocation Admowledgement of such Is by
signature below.I dedare that I am the owner and I further declare that I am entitled to receive thb permit and to do the work as proposed.I have . .
oblalned parrotsstan from al the ne91110sary parties,inducting any easement holder or parties of interest regarding this project.The owner or legal
representative,represents that the Information provided is aoaaate and grants employees of Mason County access to the above described property
and structure(s)for review and InspactIon.This pennitfapplcatlon becomes null&void ework or authorized zed constriction Is not commenced.dthin 180
days or if construction work Is suspended fora period of 180 days.
PROOF OF NTINUATIO OF WORK ON THIS PERMIT 19 BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT PUCATIO F 180 AYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08A2) , //
X //7GD
Signature of OWNER(Must be signed bvthe OWNER)
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-�D1�P�T� '��.�'•'-� �APPRQ� DAa4?�'':�' _D„I�I��'•. .. •. -- -•-
BUILDINGDEPARTM T .
PLANNING DEPARTMENT
FIRE MARSHAL J
PUBLIC HEALTH V 3/te- z trim cower rn .
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A)Drainfield/Rese e requires 10'setback from footing/fount ations
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J,' � .- ti DECEIVED
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t• 3j340U6000v ,,,,_ ... ..
4 • 615 W:��der Street
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° Site Address (Zoom in to 1:3,000)
Sources:Led,HERE,Garmin,Intermap,increment P Corp.,GEBCO.USGS,
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Mason County WA GIS Web Map Application
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