HomeMy WebLinkAboutBLD2023-00636 - BLD CD Environmental Health Review - 6/8/2023•Its
Permit No:?ki 2OL 3 -C,V(&
MASON COUNTY
COMMUNITY DEVELOPMENT RECEIVED
Permit Assistance Center,Building,Planning /�
BUILDING PERMIT APPLICATION JUN 0 6 202 ✓G� 42
00
PROPERTY OWNER INFORMATION: CONTRACTOR INF� I O�T}der Stre�C cjG ,,at�
NAME:Forest Majuere LLC NAME:N/A Q F t
MAILING ADDRESS:2460 Westlake Ave N Boat St MAILING ADDRESS:
CITY:Seattle STATE:WA ZIP:98t09 CITY: STATE: ZIP:
PHONE#1:206-953-8275 PHONE: CELL:
PHONE#2: EMAIL: _ X
EMAIL:CMAJOR@CMAJORPR.COM L&I REG# EXP. / /
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PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER❑ D Z
NAME David Taber/Neiman Taber Architects EMAIL dt@neimantaber.com r
MAILING ADDRESS 1435 34th Ave CITY seank STATE WA zip 98122 ql
PHONE 206-760-555° CELL 317.62344°1 = rfl
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PARCEL INFORMATION: —{
PARCEL NUMBER(12 Digit Number)22010-30-91002 ZONING R-10
LEGAL DESCRIPTION(Abbreviated) NE 1/4 SW 1/4 SECTION 10,TOWNSHIP 20 NORTH RANGE 2 WEST,W.M. FIRE DISTRICT SHELTON r
SITE ADDRESS 520 EAST SOUTH ISLAND DRIVE CITY SHELTON 98584
DIRECTIONS TO SITE ADDRESS Take right onto into driveway off of E South Island Dr.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESEI NO 0 SNOW LOAD:15 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION 0 REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) Vacation house
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS2 NUMBER OF BATHROOMS 3
HEATED STRUCTURE? YES(whole Bldg)Q YES(Part/sI of Bldg)0 NO 0
DESCRIBE WORK New two story 2,160 sf residence
SQUARE FOOTAGE:(proposed)
1ST FLOOR 1600 sq.ft. 2ND FLOOR 560 sq.ft. 3RD FLOOR"la sq.ft. BASEMENT Na sq.ft.
DECK 17° sq.ft. COVERED DECK 100° . sq.ft. STORAGE rya sq.ft. OTHER ma sq.ft.
GARAGE N/A sq.ft. Attached 0 Detached❑ CARPORT n/a sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERI , $ '-,/
I 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 0 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 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 CO UATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT I 0 OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X 64/013
Signature of OWNER st be signed by the OWNER). -Date
DEPARTMENTAL REV 1 APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL ,�-/,
PUBLIC HEALTH V j,0 ?(300a (v,1W 4erj.s al(J
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