HomeMy WebLinkAboutBLD2023-00953 - BLD CD Environmental Health Review - 8/11/2023 DocuSign Envelope ID:94COFD54-0581-459E-A506-4701907B14D4
'''`" MASON COUNTY COMMUNITY SERVICES Permit No: )LD "DO 3
PERMIT ASSISTANCE CENTER: R E C E!\! D
i .BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
)I•ii... F� 615 W.Alder Street,Shelton,WA 98564 E N�AL
Wit, — Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone E ill!��
.r, ' Beltair(360)275-4467•Phone Elma:(360)482-5269 "'S.+h�7iiitJJJJ��,VVV
", BUILDING PERMIT APPLICATION uu
615 W. A1 r
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Prime Location and Situations LLC NAME:SOUTH SHORE CONSTRUCTION INC
MAILING ADDRESS: 113 E Terrace Dr MAILING ADDRESS:PO BOX 963
CITY: Belfair STATE: WA ZIP:98528 CITY:BELFAIR STATE:WA ZIP:98528
PHONE#1: 360-277-7206 PHONE:360-27543818 CELL:
PHONE#2: EMAIL:southshore0q.com
EMAIL:robflath96Qgmail.com L&I REG#SOUTHSC016NL EXP._/_/_
PRIMARY CONTACT: OWNER❑ CONTRACTOR 9/ OTHER❑
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
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PARCEL INFORMATION: M
PARCELNUMBER(12 Digit Number) 321 3431 0001 0 ZONING RR5 uZI
LEGAL DESCRIPTION(Abbreviated)TR 1 OF NE SW FIRE DISTRICT AUGRE 1
SITE ADDRESS 1170 E Mason Lake Rd CITY Belfair
1 20--
DIRECTIONS TO SITE ADDRESS From Highway 3 go North on E Mason Lake Rd.Site is 1 Mlle North on the Rt.(Across from 1161 E
CEIVED
Mason Lake Rd.)
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO' 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 V ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence.Garage,Commercial Bldg,Etc)Residence
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole Bldg) ' YES(Part[s)of Bldg)❑ NO❑
DESCRIBE WORK Install new MH for residential use
SOUARE FOOTAGE:(proposed)
1ST FLOOR 1544 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 1'HE FLOOR PLAN REQUIRED*
MAKE Manufacturing West INC MODEL Dream-481 F YEAR 2023 LENGTH 48
WIDTH 28 BEDROOMS 3 BATHS 2 SERIAL NUMBER N/A
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC V SEWER❑ / NEW V 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 0 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 at 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 penniUapplication becomes null&void if work or authorized construction is not commenced within 160
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)
�—•... 7/20/2023
Voku+ RA,
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 �� �,,�,,J)
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