HomeMy WebLinkAboutBLD2023-00412 - BLD CD Environmental Health Review - 4/20/2023 Permit Noilej 2O23- DO'4 I a
MASON COUNTY RECEIVED
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_ COMMUNITY DEVELOPMENT
`rt 1 ' Permit Assistance Center,Building,Planning APR 18 2023
BUILDING PERMIT APPLICATION 615 1 A • -r Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Luke&Mandy Manning NAME:Lexar Homes/Savannah Robinson
MAILING ADDRESS:330D 21st Ave SW Apt H8 MAILING ADDRESS:1213 Long Rd
CITY:Tumweter STATE:WA ZIP:08512 CITY:Centralia STATE:WA ZIP:98531 �M
PHONE#1:360-490-0068 PHONE:360'807-7849 CELL: 360-669-s858 W
PHONE#2: EMAIL:srobinson@lexarhomes.com
EMAIL:luke.mandy@juno.com L&I REG#LEXARH•86205 EXP.6/30/2023 APR 2 0 2023
PRIMARY CONTACT: OWNER 0 CONTRACTOR❑ OTHER 0 RELIED
NAME EMAIL 1
MAILING ADDRESS CITY STATE ZIP _
PHONE CELL = X
PARCEL INFORMATION: rTl 0
PARCEL NUMBER(12 Digit Number)42125-11-50030 ZONING > Z
LEGAL DESCRIPTION(Abbreviated) LOT 3 OF LLS#06-02 PTN OF NE114 S 33/229&230 FIRE DISTRICT
SITE ADDRESS°E Pacific Ridge CITY Shelton = M
DIRECTIONS TO SITE ADDRESS Continue straight to stay on US-101 N,Turn right onto E Brockdale Rd.Turn left onto E McReavy Rd,
Turn right onto E Pacific Ridge,Destination is on your Right.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO 0 SNOW LOAD:_-psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)Resbence
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS3 NUMBER OF BATHROOMS2
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Part[sl of Bldg)0 NO 0
DESCRIBE WORK New 3 Bedroom SFR
SQUARE FOOTAGE:(Proposed)
1ST FLOOR2249 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft-
DECK sq.ft. COVERED DECK387 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE780 sq.ft. Attached Detached 0 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 0 SEWER 0 / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO❑ If yes.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.
EXISTING BEDROOMS 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 descr bed 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 COUNTYMORE
WILL
CODEL CAUSE4 g 42 THE APPLICATIONJ TO BE EXPIRED.(MASON
X �� T ,I( (gId�
Signature of OWNER(Must be signed by the OWNER) I ! Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHALS _
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