HomeMy WebLinkAboutBLD2023-00102 - BLD CD Environmental Health Review - 1/25/2023 Ilk
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'•�t' . ASON COUNTY COMMUNITY SERVICES Permit No: 7t l L,'I -( 6 02.
,;' iCs •ERMIT ASSISTANCE CENTER: RECEIVED
g M ',S BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
' 0 615 W.Alder Street,Shelton,WA 98584
( ) \\� JAN 25 2023
-.7 f " Phone Shelton:(360)427-9670 ext. 352•Fax: 360 427-7798 Phone
',i ..1/ Belfair.:(360)275-4467•Phone Elma:(360)482-5269
�'' �tft:��O 615 W. Alder Street
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: rn
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NAME:Scott Boyer NAME:Berwick's Mobile Home Service
MAILING ADDRESS:12216 Corliss Avenue North MAILING ADDRESS:P,O.Box 1563 rn 0
CITY:Seattle STATE:WA ZIP:98133 CITY:Puyallup STATE:WA ZIP:98371
PHONE#1:206-235-0935 PHONE:263-6°6-9323 CELL: 253-6°1-9323 )%s Z
PHONE#2: EMAIL : EXP. / / rn
EMAIL:boyerscott1@gmail.com L&I RE( #WA UBI No.602 185 987
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PRIMARY CONTACT: OWNER 0 CONTRACTOR❑ OTHER❑ —"'4
NAME Scott Boyer EMAIL boyerscottl@gmail.com
MAILING ADDRESS 12216 Corliss Avenue North CITY Seattle STATE WA ZIP98133 r
PHONE 206-235.0935 CELL 206-235-0935
•
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 222065200039 ZONING RR 5 Acre
LEGAL DESCRIPTION(Abbreviated) TAHUYA RIVER VALLEY DIV#2 TR 39 FIRE DISTRICT Station 61
SITE ADDRESS281 NE Snowcap Drive Tahuya,WA 98588 CITYTahuya
DIRECTIONS TO SITE ADDRESS In Belfair,turn west on to Highway 300,continue SW for 4 miles,just past Belfair State Park,
turn right on to NE Belfair Tahuya Road,drive west approx 7 miles,turn left on to NE Tahuya River Road,turn right on to NE Snowcap,281 on left.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES0 NO ❑ SNOW LOAD:25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE ❑ RIVER/CREEK❑ POND ❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW D ADDITION 0 ALTERATION 0 REPAIR❑ OTHER ❑
USE OF STRUCTURE (Residence,Garage,Commercial Bldg,Etc.)Residence
IS USE: PRIMARY 0 SEASONAL ❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES (Whole Bldg) 0 YES (Part[s]of Bldg) 0 NO ❑
DESCRIBE WORK Placement of manufactured home,relocated from mobile park which is closing,on vacant,level lot with approved septic design
SQUARE FOOTAGE: (proposed)
1ST FLOOR 1'440 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 0 Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE Golden West MODEL N/A-No model name given by manuf. YEAR 1974 LENGTH 60'-°•
WIDTH 24'-0" BEDROOMS 2 BATHS 2 SERIAL NUMBER 11908
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC D SEWER❑ / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES D NO ❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NOD EXISTING SQ.FT. 1,44°
EXISTING BEDROOMS 1.440 PROPOSED BEDROOMS 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)
Dig tarty s'gned by soon Boyer 1/17/23
X Scott Boyer DN:C=US,E-sconb@mlthun.com,D=Milhun,CN.Seon eoyor
Date:2023.01.17 12.32.48-08'00' Date
Signature of OWNER (Must be signed by the OWNER)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL PUBLIC HEALTH !'I T O l7 Pa 261, (61(,I)
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