HomeMy WebLinkAboutBLD2023-00195 - BLD CD Environmental Health Review - 3/31/2023 0�,r`' p'- 4, MASON COUNTY COMMUNITY SERVICES Permit No) 4 ZO22 ( ")I9►S
e PERMIT ASSISTANCE CENTER: ;E C E IV E V
-�,` •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
.j I• 'p 615 W.Alder Street,Shelton,WA 98584
f t Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone FEB 19 2023
.. ` - - Belfair:(360)275 4467.Phone Elma:(360)482-5269
BUILDING PERMIT APPLICATION .;15 W. Alder Street
PROPERTY OWNER INFORMATION: � CONTRACTOR INFORMATION:
NAME: David 8 Laurie Sobocinski NAME: TRINITY CONSTRUCTION SERVICES,LLG
MAILING ADDRESS: 1441 N Potlatch Dr MAILING ADDRESS: 81 N GLALLAM PL
CITY: Hoodsport STATE: INA ZIP:98548 CITY:HOODSPORT STATE: I^IA ZIP: 98548 rn
PHONE#1: 20E-113-1919 PHONE: 253.263.3341 CELL: z
PHONE#2: EMAIL: cmoss@trinitycs.IIc C
EMAIL: seattleseven@comcast.net L&I REG# TRINIG5852L2 EXP. b/30/2023
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑x OTHER❑
NAME CHRISTIAN MOSS EMAIL cmoss[cOtrinitucs.IIc rn 0
MAILING ADDRESS 81 N GLALLAM PL CITY HOODSPORT STATE YVA Z 98548 > Z
PHONE 253.263.3347 CELL
PARCEL INFORMATION: m r4,[ R = M
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PARCEL NUMBER(12 Digit Number) 423185100001 ZONING RR5 f 'S "
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LEGAL DESCRIPTION(Abbreviated) LAKE CUSHMAN#4 TR 01 FIRE DISTRICT ..--
4D
SITE ADDRESS 1441 N Potlatch Dr CITY Hoodsport
DIRECTIONS TO SITE ADDRESS from US-101 N turn L onto WA-119 N,turn L at N Mount Church Dr,straight on ,
Tebo Way,turn L onto N Potlatch Dr
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES® NO❑ SNOW LOAD: 55 .sf
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❑ ADDITION V ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence.Garage.Commercial Bldg,Etc) residence
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IS USE: PRIMARY❑ SEASONAL t� NUMBER OF BEDROOMS 1 NUMBER OF BATHROOMS 1.5
HEATED STRUCTURE? YES(Whole Bldg)IV YES(Perils]of Bldg)❑ NO❑
DESCRIBE WORK two-story addition to existing cabin
SOUARE FOOTAGE: (proposed) • f erelo G1zt, 0 V1A SO"70 'ha
1ST FLOOR
128 sq.ft. 2ND FLOOR 128 sq.ft. 3RD FLOOR sq.ft. BASEMENT ��sq.ft. •
•DECK 4B sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER 56 IG sq,ft.6 As
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTLIREMTUME INFORMA I i6 . *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAK MODEL Y LENGTH
TH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC® SEWER❑ / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES® NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO®
EXISTING SQ.FT. 418
EXISTING BEDROOMS 1 PROPOSED BEDROOMS 1 TOTAL BEDROOMS 1
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)
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Signature of OWNER(Must be sinned the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL 7 ^�
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