HomeMy WebLinkAboutBLD2023-00631 - BLD CD Environmental Health Review - 6/6/2023 MINIM
Permit No:�1e1 / D91))'00(O,
.,,,,„4z.--... MASON COUNTY
COMMUNITY DEVELOPMENT RECEIVED
)y ,F'. Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION
JUN052023
PROPERTY OWNER INFORMATION: CONTRACTOR INFORM/6116 M/. Alder St et ✓G- •
NAME:Cameron Jurgensen NAME:Cameron Jurgensen
MAILING ADDRESS:PO BOX 791 MAILING ADDRESS:PO BOX 791 FCs 6'
CITY:AIIyn STATE:WA ZIP:98524 CITY:AIIyn STATE:WA LIP:98524 NZ/_ 'b
PHONE#1:253-380-9250 PHONE: CELL:253-380-9250 F� (17
PHONE#2: EMAIL:camjurgensen@gmail.com rr
EMAILcamjurgensen@gmail.com L&I REG# EXP. / / —~
PRIMARY CONTACT: OWNER 0 CONTRACTOR❑ OTHER❑ ----
NAME
Cameron Jurgensen EMAIL camjurgenen@gmail.com
MAILING ADDRESS PO BOX 791 CITY Allyn STATE WA Z1P98524
PHONE CELL253-38o-925o r7. J
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PARCEL INFORMATION: r ?
PARCEL NUMBER(12 Digit Number)122171400050 ZONINGRRS
LEGAL DESCRIPTION(Abbreviated)TR 5 OF GOVT LOT 2 S 52/206 FIRE DISTRICTCentral Mason ` 7
SITE ADDRESS790 East North Bay Road CITYAIIyn
DIRECTIONS TO SITE ADDRESS Heading North on Hwy 3- Once past the Port of Allyn, stay STRAIGHTo ;,>
Continue 0.8 miles on East North Bay Road and the driveway to the home will be on the right(East] (--
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO 0 SNOW LOAD:25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all Mai apply)
SALTWATER 0 LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF 0 STREAM ❑
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION❑ REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage.Commercial Bldg.Erc)Residenee
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS1 NUMBER OF BATHROOMS1
HEATED STRUCTURE? YES(Whole Bldg) .❑ YES(Parr[s]ofBldg)❑ NO 0
DESCRIBE woRKRaising home and adding a 1 bedroom addition to the Westside (back) of the buildirr
SQUARE FOOTAGE:(proposed)
1ST FLOOR288(Ps sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached 0 Detached❑ CARPORT sq.ft. Attached❑ Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRE9*
MAKE MODEL YEAR LENGTH
W H BEDROOMS BATHS SERIAL
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER ID / NEW❑ EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO 0 Ifyes.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOD EXISTING SQ.FT.726
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 1 TOTAL BEDROOMS 1
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.
PRO(nf'.OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLI \TION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
I COUNTY CODE 14.08.42)
X I (a\/ --
\,Signature of OWNER(Must tie signed by the OWNER) ' 1 ' Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH I✓/) 1130
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RR5 Zoning Y'�`'>� , r' `.,.II.nIor..,. 0 ■
Front Yard Setback.25'. ° a 1'�
Side& Rear Yard Setbacks. Residential dwelling l` D o bawl 0-0
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and accessory structures is 20'. j"�$ m z 'A.
OR 10%width of lot if not more than 100'wide I ■
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OR approved ADV
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07/03/2023 x ISI
APPROVED ...................................................
MASON COUNTY DCD PLANNING
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by Scott ; '
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EH APPROVED
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for
N VAii D.Anderson 08/30l2023
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Existing Well Location _ ° ,, . iN • m Existing Propane Tank
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\�, Existing Sewer Location
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Proposed\Addition 8 . .._,i, 41.2
Existing Home__ ,`'' 14P4 -
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Existing Deck --- p
etaining walls are not permitted in the shoreline v'
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