HomeMy WebLinkAboutBLD2023-00562 - BLD CD Environmental Health Review - 7/26/2023 .5\o' `•`'4titi, MASON COUNTY COMMUNITY SERVICES Permit No:�L.OaO3
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�� PERMIT ASSISTANCE CENTER: R' 7. r 1\,/7 ,
n 6 •BUILDING •PLANNING •PUBLIC HEALTH•FIRE MARSHALzx 9 615 W.Alder Street,Shelton,WA 98584 if-ta0
'---... - 3' Phone Shelton:(360)427-9670 ext. 352•Fax:(360)427-7798 Phone I
9<y< ,y� Belfair:(360)275-4467•Phone Elma:(360)482-5269 MAY 1 8 2023
1 UL 2 61023
t -•Ri. v-AN• 615 W. Alder S eet
BUILDING PERMIT APPLICATION ENVIRO • D
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATMALTH
NAME: Vince I flif�'�eerl Cl% ,�rY1 �'lG NAME:HiLine Homes
�
MAILING ADDRESS ,0i b.) O .4Iock a` . ge,‘ MAILING ADDRESS: 11306 62ND AVE E
CITY: (_Ir,-,c, STATE: Cjvl ZIP:Cig .f( CITY:PUYALLUP STATE:MA ZIP:98373
PHONE#1: ;3I,0-L1-90-jgo(3 PHONE:253-840-1849 ( CELL:
PHONE#2:3(r;().- -Mg- OL S I EMAIL :Pre-construction@hilinehomes.com
EMAIL: 13EAIJZalgb.)-( In,Si-N•Catm • L&I REG #HILINH•983BD EXP. 11 / 8 /23
PRIMARY CONTACT: OWNER ig CONTRACTOR ❑ OTHER❑
NAME MY\Eeh4 C•ivr +mac. EMAIL 6E-PtJVt2/:hS )OIMSn.Corn
MAILING ADDRESS ` CITY F1vrc. STATE 6....)t4 ZIP CkciSqk
PHONE 3(0D- 490-1'g"13 C LL 3ko-4cio-- 1SScl3
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) ipto(GS-3 1e€a 1 ZONING
LEGAL DESCRIPTION (Abbreviated) T1 I Or-SP ° S7 A F 4 S 7(,, I3S FIRE DISTRICT �D.
SITE ADDRESS 7)01 Lk) rr 4'IDtK-by-CAAR CITY L rr
DIRECTIONS TO SITE ADDRESS 4 m►Ie5 pC i' YYIL n K i r '4- 5 CJAAc:)I on tF c}
IS THE PROJECT WITHIN 300 I+C OF SLOPE(S)GREATER THAN 14%: YES14 NO ❑ SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER ❑ LAKE ❑ RIVER/CREEK ❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM 0
TYPE OF WORK: NEW ADDITION ❑ ALTERATION 0 REPAIR 0 OTHER ❑
USE OF STRUCTURE (Residence,Garage,Commercial Bldg,Etc.)residence
IS USE: PRIMARY ® SEASONAL ❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES (Whole Bldg) ❑< YES (Part[s]of Bldg)) NO 0
DESCRIBE WORK stick-built construction on concrete foundation w/crawlspace
SQUARE FOOTAGE: (proposed)
1ST FLOOR2.041 sq. ft. 2ND FLOOR sq. ft. 3RD FLOOR sq. ft. BASEMENT sq.ft.
DECK sq. ft. COVERED DECK 140 sq. ft. STORAGE sq. ft. OTHER sq. ft.
GARAGE 484 sq. ft. Attached El Detached 0 CARPORT sq. ft. Attached❑ 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 14 SEWER❑ / NEW 0 (-,EXISTINGY]_..
PLUMBING IN STRUCTURE? YES' NO ❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NOXI EXISTING SQ. FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 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&void if work or authorized construction 's 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)
Signature of OWNER(Must be siitned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL �1 z �'�^ /jJ���
PUBLIC HEALTH Ulf' ri/ evz, 0,6r ac( �
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