HomeMy WebLinkAboutBLD2022-00750 - BLD CD Environmental Health Review - 6/13/2022 r_,,S"`6'``%t^.� MASON COUNTY COMMUNITY SERVICES Permit No:�� �D
• • \ PERMIT ASSISTANCE CENTER:
S\•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
r •I I• 615 W.Alder Street,Shelton,WA 98584 JUN 13 2022
\ , f �r Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
Bel/air:(360)275-4467•Phone Elm:(360)482-5269
ti°''tt1�"'^ 615 W. Alder Street
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Empire Home Construction,LLC IJAME:American Home Center
—I MAILING ADDRESS:PO Box 241 MAILING ADDRESS:406 108th St S
< CITY:Kelso STATE:WA ZIp:98626 CITY:Tacoma STATE:WA ZIP:68444
PHONE#1:360-751-8062 PHONE:253-841-3600 CELL:
Z PHONE#2: EMAIL:ffulkerson05@msn.com
w 1=� EMAIL:bookkeeper.empire@gmail.com L&I REG#AMERIHC978OC EXP.9/3/2023
J PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER 0
Z < NAME sof Gootlsa" EMAIL sethg@roilawfirm.com
O w MAILING ADDRESS 1302 North I Street,Ste.C CITY T"O1^• STATE WA Z11)98403
CCT PHONE 253.753-153° CELL 353-I25.o2O8
j ri_ PARCEL INFORMATION:
Z PARCEL NUMBER(12 Digit Number) 120303180081 ZONING RR5
w LEGAL DESCRIPTION(Abbreviated) LOT 1 OF SP#866 PTN TR 8 S 2/141 FIRE DISTRICT5
SITE ADDRESS601 E Inspiration Way CITY Shelton
DIRECTIONS TO SITE ADDRESS N Hwy 3,RT R Picketing,RYE S.Island Dr,RT E Harstine Island Rd.E,LT Inspiration PT Wy„RT Stay
on E Inspiration Way
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO El SNOW LOAD:25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION❑ REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc.)Manufactured
IS USE: PRIMARY El SEASONAL 0 NUMBER OF BEDROOMS3 NUMBER OF BATHROOMS2
HEATED STRUCTURE? YES/Whole Bldg)0 YES(Part/s)of Bldg)0 NO 0
DESCRIBE WORKtnstalt manufacutred home on vacant land
SOUARE FOOTAGE:(proposed)
1ST FLOOR 1512 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK50 sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached 0 Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE Golden West MODEL Dream Series yEAR2022 LENGTH27
WIDTH56 BEDROOMS3 BATHS2 SERIALNUMBERTBD
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER 0 / NEW 0 EXISTING❑
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 0 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 described property
and structure(s)for review and inspection. This permit/application becomes null 8 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
66/o3t7oZ 2
Si a ure of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL f/�� ��(�yj/�7 ��'��,,,,�//y,� , ,,/,n-/
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