HomeMy WebLinkAboutBLD2022-00550 - BLD CD Environmental Health Review - 5/3/2022 (0,5-----$ 11'4,43/4t,. .: MASON COUNTY COMMUNITY SERVICES Permit No: bLo 2()2R— 5S)
l.. PERMIT ASSISTANCE CENTER:
s ` �x `'. BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL RECEIVED
I �(� 615 W.Alder Street,Shelton,WA 98584
z,.r ,,; =0 r Phone Shelton:(360)427-9670 ext.352•Fax.(660)427-7798 Phone MAY - 3 LDLL
Belfair,(360)275 4467.Phone Elma:(360)482 5269
BUILDING PERMIT APPLICI ICI Alder St PROPERTY OWNER INFORMATION: n VI RO N M E NTAL
NANWPIEOME CONSTRUCTION LLC N�Ame an Home Center HEALTH
MAILING ADDRESS:P 0 BOX 241 MAILING ADDRESS: 406 108th St S
CITY: KELSO STATE:WA ZIP:98626 CITY: Tacoma STATE: WA ZIP:98444
PHONE#1: 360-751-8062 PHONE:253-841-3600 CELL:
PHONE#2: EMAIL: TFULKERSON05@MSN.COM
EMAIL: L&I REG#AMERIHC978OC EXP. 09/03/21
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER
NAME Megan Madsen EMAIL meganmacsen@hotmail.com
MAILING ADDRESS Pp gOX 1482 CITY Sumner STATE WA ZIP 98390
PHONE 206-396-2625 CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 32127-53-00168 ZONING RR
LEGAL DESCRIPTION(AbbreviaKE LIMERICK 4 TRACT 168 S 40/29 FIRE DISTRICT 5
SITE ADDRESS 2550 E MASON LAKE RD, CI`r3,HELTON 98584
DIRECTIONS TO SITE ADDRESS Hwy 3 north to E Mason Lake Rd, Left to property
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO g SNOW LOAD: 25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE 0 RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW X ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg Etc.) S F R
IS USE: PRIMARY® SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole Bldg)rs YES(Part[sf of Bldg)❑ NO❑
DESCRIBE WORK Install new MH
SOUARE FOOTAGE:(proposed)
1ST FLOOR 1296 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK 32 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 Golden West MODEL Dream Series YEAR 2021 LENGTH 48
WIDTH 27 BEDROOMS 2 BATHS 2 SERIAL NUMBER F/O
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC g SEWER❑ / NEW❑ EXISTING I
PLUMBING IN STRUCTURE? YES[X NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NON EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 2 TOTAL BEDROOMS 2
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 ' Madden, 1/06/2022
Signature of OWNER(Must be sinned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH Imo` I -1 l`ttZ_ (. . I‘A.5
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