HomeMy WebLinkAboutBLD2023-00529 - BLD CD Environmental Health Review - 7/10/2023 ,
MASON COUNTY R -p 8( 9 3. —6C, 5 29
COMMUNITY DEVELOPMENT
MAY 11 2023 MIX]
-" ,_„ Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICA f1 t W. Alder Street JUL 1 0%13
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: RE�EI\
NAME:"the Wright NAME:Counter-Fit Construction,Inc .•ii O
MAILING ADDRESS:111 E.Way To Tipperary MAILING ADDRESS:5619 Countryside Beach Dr NW rn 0
CITY:Shelton STATE:WA ZIP:98554 CITY:Olympia STATE:WA ZIP:98502
PHONE#1:909-273- PHONE:36°-791-5666 CELL: 360-791-5666
PHONE#2: EMAIL:counterfitconstruction@gmad.com = m
EMAIL:kelliewright13@gmail.com L&I REG#COUNTCI934JF EXP.OP/ /
L.
PRIMARY CONTACT: OWNER 0 CONTRACTOR❑ OTHER❑ a7 d03 1 D
NAME DaveKiloran EMAIL counterfitconstnudion@gmail.com
MAILING ADDRESS 5619 Countryside Beach Dr NW CITY°5''r'p'a STATE Wa ZIP985O2 r-
PHONE 380-791-6GG6 CELL 380-791-5 6
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number)32127-51-00198 ZONING Lake Limerick
LEGAL DESCRIPTION(Abbreviated)Lake Limerick 2,Tract 198 FIRE DISTRICT 5
SITE ADDRESS 441 E.St Andrews Drive CITY Shelton
DIRECTIONS TO SITE ADDRESS From Shelton,Highway 3 toward Belfair,left on Mason Lake Rd,Left on St Andrews Dr to site
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14'/0: YESO NO Q SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Ere..)Resldence
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole Bldg)Q YES(Part[s]of Bldg)❑ NO❑
DESCRIBE WORK New Single Family Residence
SQUARE FOOTAGE:(proposed)
1ST FLOOR1260 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.R BASEMENT sq.ft.
DECK sq.ft. COVERED DECK392 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached 0 Detached❑ CARPORT sq.ft. Attached 0 Detached 0
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❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS (3 TOTAL BEDROOMS j
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 ol 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
T APPLICATIO F MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X i 5- - II- ia3
f OW (Must be signed by the OWNER) Date
DEPARTME fEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL `._ f
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