HomeMy WebLinkAboutBLD2023-00009 - BLD CD Environmental Health Review - 1/5/2023 MASON COUNTY COMMUNITY SERVICES Permit No: -vT= (ZOO
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7. PERMIT ASSISTANCE CENTER: - //
�P .BUILDING.PLANNING•PUBLIC HEALTH• w`
2FIREMARSHAL�C��'V /�U
.., 615 W.Alder Street,Shelton,WA 98584 `/f 1
':'_:,,,,,..F- Phone Shelton:(360)427-9670 ext 352•Fax:(380)427-7798 Phone JAN — 5 LU2, v1
��� Belta/r (350)275 4487.Phone Elms(360)482-5269 MENTAL.
BUILDING PERMIT APPLI6 (OTIAIder Stree HEALTH
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:�NVIRON
NAME:Juro Mreic end Jadd Campbell NAME:Coval Homes
MAILING ADDRESS:2231 180TH ST SW MAILING ADDRESS:1950 Pottery Ave
CITY:Lynnwood STATE:We ZIP:98037 CITY:Port Orchard STATE:WA ZIP:98366
PHONE#1:Juro 208 359 1115
PHONE:380-662-1520 CELL:
PHONE#2:Jam-25-260-1238 EMAIL:info at covemomes.com
EMAIL: yuromrelc(yahoo.com,)dcampbel184@gmall.00m L&I REG#COVALHL8940D
EXP. 11/4 /23
PRIMARY CONTACT: OWNER❑ CONTRACTOR 0 OTHER p
NAME C'ymer Mattson-Mattson Land ConsuMrq
doom
MAILING ADDRESS 21227 88th Ave E CMAIL ts," andoonwltQkio STATE
PHONE 253-228.7492 CELL CITY Wets," WA ZIP e8338
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 320215305050 ZONING Neighborhood Residential
LEGAL DESCRIPTION(Abbr>viated) SHORECREST TERRACE 3RD ADD BLit5 LOT:50 FIRE DISTRICT
•
SITE ADDRESS 141 E Olympic Place Shelton,WA 98584 CITY Shelton
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO Q SNOW LOAD:25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Ow t all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW Q ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc)Sl1191e Femiy Residence
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2.5
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Part[s)of Bldg)0 NO❑
DESCRIBE WORK buld a new single family residence
SQUARE FOOTAGE;(proposea,
1ST FLOOR 2301 sq.ft. 2ND FLOOR
sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK 300 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE 578 sq.ft. Attached 0 Detached❑ CARPORT sq.ft. Attached❑ Detached❑
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 O SEWER❑ / NEW p EXISTING Q
PLUMBING IN STRUCTURE? YES 0 NO❑ byes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YEt NOD EXISTING SQ.FT. 0
EXISTING BEDROOMS 0 PROPOSED BEDROO TOTAL BEDROOMS 3
OWNER acknowledges that submission of inaccurate infonnatton 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 l am entitled to receive the permit and to do the work as proposed.I have
obtained permission front 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 etructure(s)for review and inspection. This permit/application becomes nut&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)
1 1r,� • /111 ( r,NI.l I (iI ri`.(•I I 12/29/2022
Signature of OWNER(Mtizt be uar>:ad bvthe OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDmONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL /- PUBLIC HEALTH Li i) ��/�C�jt,'(� (c2q//109S elik(L f.
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