HomeMy WebLinkAboutBLD2022-01572 - BLD CD Environmental Health Review - 12/28/2022 ,�c`°'r'^^1t MASON COUNTY COMMUNITY SERVICES Permit No: WCJ_d__ dl
PERMIT ASSISTANCE CENTER:
.� ••BUILDING••PLANNING••PUBLIC HEALTH••FIRE MARSHAL
ifi j It 615 W.Alder Street,Shelton,WA 98584 (� (� p rtf�rlrl
=t. "/� " Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone DEC O Ll)f/
v Befair:(360)275-4467•Phone Elma:(360)482-5269 1 \3`)
11jv3,, 615 W. Alder Stre
BUILDING PERMIT APPLICATION m
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: • Z
NAME:Kevin Hauenstein NAME:Robert Rodriguez L4 vy\<'0Cv(VOA rLej-= , s
MAILING ADDRESS:14781 Horseshoe Ave SW MAILING ADDRESS: V,(),60.A. lb,L =
CITY:Port Orchard STATE:WA ZIP:98367 CITY:Gig Harbor STATE:WA ZIP: I'i'/1 3 m 0
PHONE#1:317-697-7553 PHONE: CELL: 253-224-4172 D Z
PHONE#2: EMAIL:anothernessage@hotmail.com I
EMAIL:kevin.l.hauenstein@gmail.com L&I REG#LOrY C'1;'('c.412 L.)u.. xp. 11 /2I_2‘;1,-*--1 El
PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER 0 = m
NAME 1.vm"...""" EMAIL kevin.l.hauenstein@gmail.com G
MAILING ADDRESS 14781 Horseshoe Ave SW CITY PollO.dwre STATE WA ZIP38367 ,....1
PHONE er7-697-7es3 CELL 3'7d974553 D
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PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number)32232-52-08013 ZONING
LEGAL DESCRIPTION(Abbreviated)UNION-GRAYS HARBOR a UCRR ADD aUE 8 LOT 13-18 S 5e'14t FIRE DISTRICT
SITE ADDRESS XXXX Tacoma Street CITY Un101
DIRECTIONS TO SITE ADDRESS
IS TILE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO 0 SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Cheek a!!that appl>):
SALTWATER❑ LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION 0 REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc)Residence
IS USE: PRIMARY D SEASONAL D NUMBER OF BEDROOMS3 NUMBER OF BATHROOMS2
HEATED STRUCTURE? YES({{'hole Bldg)0 YES(Perils)of Bldg)0 NO 0
DESCRIBE WORKGarage is not heated
SQUARE FOOTAGE:(proposed)
1ST FLOOR1632 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT 1+
DECK sq.ft. COVERED DECK85 sq.ft. STORAGE sq.ft. OTHER'S q.ft. i-1L1,e-.t.6
GARAGE 333 sq.ft. Attached 0 Detached❑ CARPORT sq.ft. Attached 0 Detached 0 YO"-ht.'
MANUFACTURED HOME INFORMATION: *4 CO "FLU REQUIRED*
MAKE MOD YEAR LENGTH
WIDTH BE OMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER❑ / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS`..g TOTAL BEDROOMS t.: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 acmmas to the above described property
and structure(s)for review and inspection. This permit/application becomes null 8 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 APPLIC ION OF 180 DAY F MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
gna re f W ER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT t� r�
FIRE MARSHAL •
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'At PROJECT:XJX SF 3 BR ASPEN CREEK ENGINEERING
,{ t 2 CONOCO?COn3[UC•uor 12819 SE 38TH ST 9222 I BELLEW E,WA 96006
!� �l Iw1'rnCowlnSWEET U1ION.R'A90393 T.(253)929.6562
PM 327.32.524201