HomeMy WebLinkAboutBLD2023-00397 - BLD CD Environmental Health Review - 4/18/2023 �. :At4G. MASON COUNTY COMMUNITY SERVI' S 'ermit No: I ��' � ' ';�"j' "
cs^ PERMIT ASSISTANCE CENTER: �� • .
01,4 •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MAR' AL ^pA CD
• 0 615 W.Alder Street,Shelton,WA 98584 ^1 1 J +
'" _ ' Phone Shelton:(360)427-9670 ext.352•Fax:(360)427- •:Ph �?
9 �` yy Belfalr.(360)275 4467.Phone Elma:(360)482-5269 `C&, O R 13 2023,
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BUILDING PERMIT APPLICATI• 61 ' W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: m
NAME:DAVID&BECKY ANDERSON NAME:FOX CUSTOM HOMES INC. z
MAILING ADDRESS:PO BOX 149 MAILING ADDRESS:PO BOX 111349 C
CITY:WAUNA STATE:WA ZIP:MSS CITY:TACOMA STATE:WA ZIP:98411-1349 = Do
PHONE#1:208-818-2291 PHONE:253-474-2619 X104 CELL: t..f., O
PHONE#2: EMAIL :ADMIN@FOXCUSTOMHOMES.COM
EMAIL: L&I REG#FOXCUCH931MQ EXP. 83423
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER 0 = E
NAME FOX CUSTOM HOMES INC EMAIL ADMIN@FOXCUSTOMHOMES.COM c
MAILING ADDRESS SAME AS ABOVE CITY STATE ZIP
PHONE CELL -,-'
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PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 12219-50-00052 ZONING
LEGAL DESCRIPTION(Abbreviated) LAKELAND VILLAGE 7 LOT:52 FIRE DISTRICT
SITE ADDRESS270 E WESTLAKE DR.N CITY
DIRECTIONS TO SITE ADDRESS ALLYN HWY 3,WEST ONTO E WESTLAKE DR N.FOLLOW AROUND LAKE TO END OF ROAD
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO Q SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE D RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW D ADDITION ❑ ALTERATION 0 REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)SFR
IS USE: PRIMARY 0SEASONAL❑ NUMBER OF BEDROOMS -2 NUMBER OF BATHROOMS t. `S
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Parifs]of Bldg) NO❑
DESCRIBE WORKCONSTRUCTION OF A NEW SFR W/ATTACHED GARAGE
SQUARE FOOTAGE: (proposed)
1ST FLOOR 1612 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT 858 sq.ft.
DECK sq.ft. COVERED DECK1`4 sq.ft. S SAGE�� �''�sq.ft. OTHER412 sq.ft.
GARAGE`42 sq.ft. Attached 0 Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH ,�"--'-
WI BEDROOMS BATHS SERIAL
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER 0 / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES EI NO❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 2 TOTAL BEDROOMS 2
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)
D{V%oll EAs1a'ektort Apr 13,2023
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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 Nis ,Q��� Q
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