HomeMy WebLinkAboutBLD2023-00156 - BLD CD Environmental Health Review - 2/7/2023 ,0'` MASON COUNTY COMMUNITY SERVICES Permit No: /tY
PERMIT ASSISTANCE CENTER:
'c011 •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
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6 615 W.Alder Street,Shelton,WA 98584 ���` FEB 07 2023
G. Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone /�
Belfair.(360)275-4467•Phone Elma:(360)482-5269
rw uy.. 1,ra'� 615 W. Alder Street
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Carl and Theresa Anderson NAME:Call Anderson
MAILING ADDRESS:1°265 Rockingham Dlr .Saul1(41601s MAILING ADDRESS:10265 Rockingham Drive,Suite 100#6015
CITY:Sacramento STATE:CA ZIP:95827 CITY:��mento STATE:CA ZIP:9527 ITI
PHONE#1:530-515-0551 PHONE: CELL:PHONE#2:530-945-5975 EMAIL: z
EMAIL:chuckyniranky®gmail.com L&I REG# EXP. /_/_
PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER 0 = DO
NAME CadAnderwn EMAIL chuckyniranky@gmail.com m O
MAILING ADDRESS 10265 Rockingham Drive,Suite 100#6015 CITY sacwmanto STATE CA ZIP95827 D Z
PHONE 530-515-0551 CELL r
PARCEL INFORMATION: =
PARCEL NUMBER(12 Digit Number) 12119-53-00035 ZONING RR
LEGAL DESCRIPTION(Abbreviated) HARTSTENE POINTE#4 LOT:35 s 50/149 FIRE DISTRICT 5
SITE ADDRESS474 E Chesapeake Dr. CITY Shelton r--
DIRECTIONS TO SITE ADDRESS Cross bridge onto Harstine Island. L at Stop sign.4.5 miles to gate.
R onto East Pointe Drive,East.R on E Chesapeake Drive.Property on the right.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO❑ SNOW LOAD:2 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Cheek all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION❑ REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence.Garage,Commercial Bldg,Etc.)Residence
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS3 NUMBER OF BATHROOMS2.5
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Pan/si of Bldg)❑ NO 0
DESCRIBE WORK New build of a residential home
SQUARE FOOTAGE:(proposed)
1ST FLOOR960 sq.ft. 2ND FLOOR14°8 . sq.ft. 3RD FLOORn/a sq.ft. BASEMENTn/a sq.ft.
DECK998 sq.ft. COVERED DECK rile sq.ft. STORAGE538 ' sq.ft. OTHERn/a sq.ft.
GARAGE650 sq.ft. Attached 0 Detached 0 CARPORTn/a sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER El / 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 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 CAUSE THE APPLICATION TO BE EXPIRED.(MASON
X �L?���COUNTY CODE 14.08.42)
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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 /�
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