HomeMy WebLinkAboutBLD2023-00007 - BLD CD Environmental Health Review - 1/5/2023 a ,a<r-riA:1� MASON COUNTY COMMUNITY SERVICES Permit No:�111 • 2 ' 1 7*-- Q
't.. �S'. PERMIT ASSISTANCE CENTER: I Li
7 ,1f •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
ifht ' '0 615 W.Alder Street.Shelton,WA 98584 i ti _ ,- ,,,)
.J. :+P Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone (( 1
�i`�" '�v Bel/air.(360)275-4467•Phone Elate:(360)482-5269 \�K
BUILDING PERMIT APPLICATION615 er Street
PROPERTY OWNER INFORMATION: CONTRACTORr INFORMATION: I —J
NAME::f S 1 4-h NAME:/`(/L OrP- Uotile SS k 02S f
MAILING A RESS:_ /,y3- W A / ; MAILING ADDRESS: o-2-I 5t ICU l v w z
R STATE: ZIP: "1 , CITY: j?° STATE: A ZIP:�.3 12
PI-ONE#l:' O(Q--ze76-- q PHONE: I°U"N7 4 �L; W =
PHONE#2: EMAIL: UY) OVYLPS%Y2/ne lo/�1
EMAIL: R b ro)o itHook t larrl L&I REG# EXP. / /_ Z <
PRIMARY CONTACT: OWNER❑ CONTRACTOR® OTHER❑
t QW
NAME Mattson Land Consulting, LLC EMAIL mattsonlandconsult@icloud.com Z =
MAILING ADDRESS 21227 88th Ave E CITY Graham STATE WA ZIP 98338
PHONE 253-228.7482 CELL Z
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number)
320215804021 ZONING Rural Resldenital 5
LEGAL DESCRIPTION(Abbreviated) SHORECREST BEACH ESTATES#1 BLK:4 LOT:21 FIRE DISTRICTA 1
SITE ADDRESS 100 E Hlllcrest Dr NW CITY
84
DIRECTIONS TO SITE ADDRESS AG SIEE RD
O SOUTH
TH H TOCOR A RIGHT
HIL ONCRESTVIEW L WOOD TO A LEFT ON HILLCREST
TIS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO 0 SNOW LOAD: 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 E ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.
reseldence
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole Bldg) x❑ YES(Part(s)ofBldg) ❑ NO❑
DESCRIBE WORK to Install a 48x27 3 bedroom manufactured home
SOUARE 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❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
mAKE Fleetwood MODEL Eagle YEAR 2022 LENGTH 44
WIDTH 27 BEDROOMS 3 BATHS 2 SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC ® SEWER Li / NEW% EXISTING❑
PLUMBING IN STRUCTURE? YES® NO ❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NO x❑ 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 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
CODE 4 CAUSE THE APPLICATION TO BE EXPIRED. (MASON
X 1(tn 12/15/2022
t,,nt K'�t�t
1i;gltatarettil+OWNER(Must be signed by the OWNER) Date
I DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL �,y
PUBLIC HEALTH e_x_ / qv-A c/A Civ..,S , )
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