HomeMy WebLinkAboutBLD2023-00605 - BLD CD Environmental Health Review - 5/31/2023 ��,,,o14('•'7 1A. MASON COUNTY COMMUNITY SERVICE Permit No:kl 2D27) - COWL)
lc. PERMIT ASSISTANCE CENTER:
s RECEIVED
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BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSH
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I 615 W.Alder Street,Shelton,WA 98584
Phone Shelton:(360)427-9670 ext.352•Fax:(360)427- 98 Pho/4j, 47
'hey.-.-_—_...->------- �y� Belfair:(360)275 4467.Phone Elma:(360)482-•:•9 'YQ'ea, AY 31 2023
BUILDING PERMIT APPL ► ' • 1 ,15 / . Alder Street
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PROPERTY OWNER INFORMATION: CONTRACTOR \ FO 'I ATION: rn
NAME: Icil21GK l`iP IN NAME:HiLine Homes
MAILING ADDRESS: 230 !;•Lt 'f3"( 121 w MAILING ADDRESS: 11306 62ND AVE E
CITY: H L 10/N STATE:k//A ZIP: g 5-84- CITY: PUYALLUP. STATE:WA ZIP:98373 T
PHONE#1: 206 4-07-3 3C5 PHONE:283-849-1849 CELL: T
PHONE#2: EMAIL : Pre-construction@hilinehomes.com D
EMAIL: f 5 rl, I'AT(LIc K 110A/3/ / . Gr1/1(L•Cat'f L&I REG#HILINH'983BD EXP. 110820
PRIMARY CONTACT: l OWNER' CONTRACTOR 0 JOTHER0�o/L�,i✓ G/`�A�L-tom Z
NAME fATR fCK 1 10l Ali. EMAIL
MAILING ADDRESS 230 i,L.1136;' izo. I,/, CITY 4.PG LTON STATE IAJ/4- ZIP Oc$4- >
PHONE CELL 7o6- 40 7-3 36 5
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 3 2-02 I-5 `1. -0 101 Z ZONING R CJ
LEGAL DESCRIPTION(Abbreviated)c,OfIr.'1.4'rM1(ll 64-0-1 a &i : 1 Lot': I9-- FIRE DISTRICT 6
SITE ADDRESS 2a° CA5- y00,./9vi! (✓I7P-• _CITY 411(LTO/I '• _
DIRECTIONS TO SITE ADDRESS 1/VA -3 i ( I G-H 1 14(,9 IF Y&),/ (2 ... G �4TO 61&i 17 tec
6, 1-t/�LCf_C7Y DA- l PT ,� /<vjGcc7V/v wA'i, 1.6rl , ciOmOvjEt,/' Oft,
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO SNOW LOAD:2-�psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER ❑ LAKE ❑ RIVER/CREEK ❑ POND 0 WETLAND 0 SEASONAL RUNOFF ❑ STREAM 0
TYPE OF WORK: NEW j' ADDITION ❑ ALTERATION ❑ REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)
IS USE: PRIMARY(SEASONAL 0 NUMBER OF BEDROOMS P--- NUMBER OF BATHROOMS I
i HEATED STRUCTURE? YES(Whole Bldg) 0 YES (Part[s]of Bldg)1E1 NO✓✓❑
DESCRIBE WORK C oNy1/LvC ri?6 4 i '2- �I)L. 6/- 0-H /a;eQ VL 3 01,2 G-A/L PrC r- V6 fl/L/a/I-1
SQUARE FOOTAGE: (proposed)
1ST FLOOR sq.ft. 2ND FLOOR 136 . sq.ft. 3RD FLOOR sq. ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK Z 02 sq.ft. STORAGE sq. ft. OTHER sq. ft.
GARAGE i 60 sq. ft. Attached a Detached❑. CARPORT X6 S sq.ft. Attached, Detached 0
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❑ / NEW EXISTING 0
PLUMBING IN STRUCTURE? YES is; NO ❑ lfyes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES NOD EXISTING SQ.FT./-I.
EXISTING BEDROOMS /I/�� _ PROPOSED BEDROOMS a- TOTAL BEDROOMS Z-
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)
X a/ li a•-✓ , �/J�—zl ( I ZU Z
Signature of OWNER(Must be skirled by the OWNER) y
Date /
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL f,,!/ f� }�,, c
PUBLIC HEALTH e — G1 Z(23 4 i' 'u.& ar
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