HomeMy WebLinkAboutBLD2023-00954 - BLD CD Environmental Health Review - 8/11/2023 DocuSign Envelope ID:24D0CFBE-BFOB-4F64-8035-1ED242113FAF n'
'`O'''Lr MASON COUNTY COMMUNITY SERVICES Permit No: [3LU�I 3" O �',(''\---9'.
�O� PERMIT ASSISTANCE CENTER:
.` •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL % {
• .I I• r •! i 615 W.Alder Street,Shelton.WA 98584 I "'•D
Py r,r -,„rI fq` Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone A Q'-
iri 'yy Beffair(360)275-4467•Phone Elm:(360)482-5269 E r4V1 FO 41-r E NTA L
rrtt� BUILDING PERMIT APPLICATION
615 W iilitsik • t
PROPERTY OWNER INFORMATION:, CONTRACTOR INFORMATION:
p+LIMe LOCJ}TI oN Er
NAME: Robert Flath 6;4.1,4.4 pnS LA ( - NAME:SOUTH SHORE CONSTRUCTION INC
MAILING ADDRESS:113 E Terrace Dr _ MAILING ADDRESS:PO BOX 963
CITY: RPlfair STATE:WA ZIP:98528 CITY:BELFAIR STATE:WA ZIP:98528
PHONE#1: 3.60-277-7206 PHONE:360-275-0818 CELL:
PHONE#2: EMAIL:southshore@q.com
EMAIL: robflath96( gmail.com IA1 REG# SOUTHSC016NL EXP. 02/102024
PRIMARY CONTACT: OWNER❑ CONTRACTOR V OTHER❑
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION: [�
PARCEL NUMBER(12 Digit Number) 32134-31-00040 ZONING RR5 '�
LEGAL DESCRIPTION(Abbreviated) TR 4 OF SURV 6/37 PCL A OF BLA#95-62#610517 FIRE DISTRICT II AUGHU 1 1 ZQ
SITE ADDRESS 1151 E Mason Lake Rd CITY Shelton `+
DIRECTIONS TO SITE ADDREssf rom highway 3 go North on E Mason Lake Rd. Site is 1 mile North and or RECEIVED
the left across from 1170 E Mason Lake Rd
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO Qi SNOW LOAD:25 psf
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 ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence.Garage.Commercial Bldg,Esc)Residence
1S USE: PRIMARY{% SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole Bldg,)/ YES(Pari[s]ofBldg)❑ NO❑
DESCRIBE WORK Install new manufactured home for residential use
SQUARE FOOTAGE: (proposed)
1ST FLOOR 1344 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❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE Clayton Homes MODEL Dream 48-1 F YEAR 2023 LENGTH48
WIDTH 28 BEDROOMS 3 BATHS 2 SERIAL NUMBER N/A
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC I" SEWER❑ / NEW NV. EXISTING❑
PLUMBING IN STRUCTURE? YES V NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ Nov EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
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 descr bed property
and structure(s)for review and inspection. This pernit/applicatlon 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)
7/26/2023
"Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL � �,,Q
PUBLIC HEALTH X1 r ,,� ,° � C""Q
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