HomeMy WebLinkAboutBLD2023-00427 - BLD CD Environmental Health Review - 4/20/2023 , MASON COUNTY COMMUNITY SERVICES Permit No: � JQ iI 9a,7
l~ $ PERMIT ASSISTANCE CENTER: R C C C I
• .+ fit. •BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL f�C [_
4.1, ,.; Y 615 W.Alder Street,Shelton,WA 98584
:` "�~+ g1Y Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone ✓
?� BeNair(360)275-4467•Phone Elm&(360)482-5269 APR 2 0 2023 (�
BUILDING PERMIT APPLI �� �
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'�� . AlderStreet
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:MIKE AND BRENDA RULE _ NAME:KIFER CONSTRUCTION LLC GS MAILING ADDRESS:441 EAST WILD FLOWER LANE MAILING ADDRESS:1515 KRESKY AVENUE
CITY:SHELTON STATE:WA ZIP:98584 CITY:CENTRALIA STATE:WA ZIP:98531
PHONE#1:503 476 2253 PHONE:360 807 4140 CELL: 360 888 7548
PHONE#2: EMAIL:CHUCK@KIFERCONSTRUCTION.ORG
EMAIL:BRENDASUE RULE@GMAIL.COM L&I REG#KIFERCL823DM EXP. 3/2/1/2024
PRIMARY CONTACT: OWNER❑ CONTRACTOR 0 OTHER❑
NAME CHARLES KIFER EMAIL CHUCK@KIFERCONSTRUCTION.ORG
MAILING ADDRESS 1515 KRESKY AVENUE CITY CENTRALIA STATE WA s31
PHONE 3608074140 CELL 36°888 7648 E NMENTAL
PARCEL INFORMATION: HEALTH
PARCEL NUMBER(12 Digit Number) 2201933303020 ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 441 EAST WILDFLOWER LANE CITY SHELTON
DIRECTIONS TO SITE ADDRESS FROM SHELTON HEAD EAST ONTO WA-3.TURN RIGHT ONTO E AGATE RD.TURN RIGHT ONTO EAST WILDFLOWER
LANE.SITE IS ON THE LEFT.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO 0 SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION❑ REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc.)RESIDENCE
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 2_
HEATED STRUCTURE? YES(Whole Bldg)D YES(Par/No./Bldg)❑ NO 0
DESCRIBE WORK CONTRUCTION OF 36X72 TWO STORY HOUSE
SQUARE FOOTAGE:(proposed)
1ST FLOOR 2036 sq.ft. 2ND FLOOR 1728 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK 640 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE 529 sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached 0 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 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 2 TOTAL BEDROOMS
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 160 days.
PROOF OF CONTINUA N OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLI A F 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X 4/20/2023
Signature of 0 ER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL PUBLIC HEALTH V7h3 (cMs't' ,t (�11
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