HomeMy WebLinkAboutBLD2023-00573 - BLD CD Environmental Health Review - 5/22/2023 •
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�,,9`r'G''' yk MASON COUNTY COMMUNITY SERVICES Permit No: f 71Gl2t$ 3- 66 -13
PERMIT ASSISTANCE CENTER: RECEIVED
',. ••BUILDING ••PLANNING •PUBLIC HEALTH•FIRE MARSHAL f1 C
`I �� • p 615 W.Alder Street,Shelton,WA 98584
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%t. f Phone Shelton:(360)427-9670 ext. 352•Fax:(360)427-7798 Phone MAY 2 2 2023
. yY Belfair:(360)275-4467•Phone Elma:(360)482-5269
'`�'•►i.,-'� 615 W. Alder Street
BUILDING PERMIT APPLICATION
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PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: z
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NAME:Gary&Diane Marshall NAME:Northwest Construction Coop Inc. �'
MAILING ADDRESS:2715 106th PI SE MAILING ADDRESS:P.O.Box 2953 L.O
CITY:Beaux Arts Village STATE:WA ZIP:98004 CITY:Olympia STATE:WA ZIP:985c z
PHONE#1:206.351.1005 PHONE:360.754.3541 CELL: 39.475.1039
PHONE#2:425.351.7351 EMAIL :info@northwestconstruction.coop r{
EMAIL:drgarym@live.com L&I REG#NORTHCCBOND EXP. 08/CCCi'
PRIMARY CONTACT: OWNER ❑ CONTRACTOR❑ OTHER❑
NAME Jason Taellious o.b.o.Artisans Group Architecture&Planning EMAIL jason@artisansgroup.com r
MAILING ADDRESS 6504 Capitol Blvd SE CITY Tumwater STATE WA ZIP 96501
PHONE 360.570.0626 CELL 206.639.7098
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 22123-75-90110 ZONING RR-5
LEGAL DESCRIPTION (Abbreviated) TR 11 EX OF SUR 10/157 TR A-1 OF SP S1445 TR 3 OF SP 82692 0621463 S 38/123 FIRE DISTRICT Mason County#4
SITE ADDRESS 1171 E Wilson Way CITY Grapeview
DIRECTIONS TO SITE ADDRESS WA-3 N for 10.2 miles>Right onto E.Grapeview Loop Rd.>Continue for 1 mile>Right onto E Wilson Way>
Continue for 1.4 miles. >Property is at the end of E.Wilson Way.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO 0 SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE ❑ RIVER/CREEK ❑ POND ❑ WETLAND 0 SEASONAL RUNOFF ❑ STREAM 0
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0 Replacement Accessory Structure
USE OF STRUCTURE(Residence, Garage, Commercial Bldg,Etc)Home office W/bathroom.
_ IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS° NUMBER OF BATHROOMS 1
HEATED STRUCTURE? YES (Whole Bldg) 0 YES (Part[sJ of Bldg.) ❑ NO ❑
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Replacement of existingaccessorystructure with a home office and bathroom.
U� ,N DESCRIBE WORK p
S SQUARE FOOTAGE: (proposed)
0 1ST FLOOR 240 sq. ft. 2ND FLOOR N/A sq. ft. 3RD FLOOR N/A sq. ft. BASEMENT NIA sq. ft.
' DECK 88 sq. ft. COVERED DECK sq. ft. STORAGE sq. ft. OTHER sq. ft.
GARAGE N/A sq. ft. Attached 0 Detached 0 CARPORT N/A 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 0 SEWER ❑ / NEW ❑ EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO 0 If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ. FT. 240
EXISTING BEDROOMS ° PROPOSED BEDROOMS ° TOTAL BEDROOMS °
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.
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
—DocuSigned by:
COUNTY CODE 14.08.42)
x an/ hays-Rau, 5/19/2023
\_96iob> rt4AI OWNER (Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH 11 gt J/j/ CC/10/1*. ie°
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