HomeMy WebLinkAboutBLD2023-00231 - BLD CD Environmental Health Review - 3/3/2023 r a`'` ''°- MASON COUNTY COMMUNITY SERVICES Permit No: 6)" L3 -OO2,3i
° f' PERMIT ASSISTANCE CENTER:( fell , , J'�
:7�®BUILDING EPLANAING IiPUBLIC HEALTH NFIRE MARSHAL 1 CE I i• 615 W.Alder Street,Shelton,WA 98584 1`I /
Phone Shelton:(360)427-9670 ext 352•Fax:(360)427-7798 Phone
\ \,j Behar(360)2754467•Phone Elme:(360)482-5269 1�
\`�, BUILDING PERMIT APPLICATION 6 "VAR
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PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: V V• Ald@r str
NAME: Donald Kind NAME: Suprema Homes eef
MAILING ADDRESS: 1607 Bonney Ave MAILING ADDRESS: 15315 50th Ave E
CITY: Sumner STATE:WA ZIP: 98390 CITY: Tacoma STATE:WA ZIP: 98446 fj
PHONE#1: 253-224-2329 PHONE: 253-331-1490 CELL:
PHONE#2: EMAIL: construction(cDsupremanomes.com - MAD 0 3 2023
EMAIL: don.kincl@gmail.com LAI REG# #SUPREHL807Q3 EXP. 11/23/24
PRIMARY CONTACT: OWNER IX CONTRACTOR❑ OTHERU RECEIVED
NAME Donald Kincl EMAIL don.kincl@gmail,com
MAILING ADDRESS 1607 Bonney Ave CITY Sumner STATE WA ZIP 98390
PHONE CELL 253-224-2329 tJ
PARCEL INFORMATION: EN V I RON!'
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PARCEL NUMBER(12 Digit Number) 121195000145 ZONING L/� • 1 N T/4 C
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT HEALTH
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SITE ADDRESS 640 Pitcairn Ave. CITY Shelton
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 F1'OF SLOPE(S)GREATER THAN 14%: YESO NO XI SNOW LOAD:_•psr
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all dna am*:
SALTWATER U LAKE U RIVER/CREEK❑ POND❑ WETLAND U SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW 01 ADDITIONU ALTERATION❑ REPAIR OTHER Li
USE OF STRUCTURE(Residence.Gauge.Commercial Bldg,Etc)_Residence
IS USE: PRIMARY X SEASONAL U NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole Bldg)0( YES(Pants]of Bldg)U NO❑
DESCRIBE WORK
SQUARE FOOTAGE: (Nroposerq
1ST FLOOR 1480 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft-
DECK sq.ft. COVERED DECK .2-ea sq.II. STORAGE sq.ft. OTHER sq.It
GARAGE_ _sq.ft.Attached❑ Detached CARPORT sq.ft. Attached U 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❑ SEWER X i NEW 0 EXISTING q0
PLUMBING IN STRUCTURE? YES XI NO❑ If yes,attach completed waterAdequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES Xt NOU EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 TOT.AL,BEDROOMS 3
OWNER acknowledges that submission of Inaccurate information may result in a stop work order or permit revocation.Acknowledgement o'such is by
signature below.I declare that I am the owner and I further declare that I am entrtled 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 perm It/application becomes null 8 void if work or authorized construction is not commences 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
NTY CODE 14.08.42)
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of NER M t I n tit WNER Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TA GS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH 41.51V5
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