HomeMy WebLinkAboutBLD2022-00751 - BLD CD Environmental Health Review - 7/1/2022 �,.>�"°'('`'tile MASON COUNTY COMMUNITY SERVICES Permit No: l �`���`� — 0 791
. PERMIT ASSISTANCE CENTER:
k ;<1•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
.1 I• 5. 615 W.Alder Street,Shelton.WA 98584
%i. '` Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
'2,. Beek(360)275-4467•Phone Elma:(360)482-5269
BUILDING PERMIT APPLICATION es
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: ....&) i77.P•.
NAME:Empire Home Construction,LLC NAME:American Home Center t. 0 e
MAILING ADDRESS:PO Box 241 MAILING ADDRESS:aos loaln St s li 7 ,2f`•'.2
CITY:Kelso STATE:WA ZIP:98626 CITY:Tacoma STATE:WA ZIP:96444 v 1/li A 'r
PHONE#1:
360-751-8062 PHONE:253-841-3600 CELL: •
PHONE#2: EMAIL:tfulkerson05@msn.com 40l c r
EMAIL:bookkeeper.empire@gmail.com L&I REG#AMERIHC978OC EXP.9/3/20�3 t°et
PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER 0
NAME Seth Good stein EMAIL sethg@roilawfirm.com ij
MAILING ADDRESS 1302 North I Street,Ste.C CITY(won STATE.WA ZIPB��O
PHONE zsaTss-tsao CELL zsazzsozoe
PARCEL INFORMATION: ilk 44
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PARCEL NUMBER(12 Digit Number) 120303190084 ZONING RRS 4?Xi t
LEGAL DESCRIPTION(Abbreviated) LOT 4 OF SP#866 PTN TR 8 S 2/141 FIRE DISTRICT5 1] 4
SITE ADDRESS607 E Inspiration Way CITY Shelton
DIRECTIONS TO SITE ADDRESS N Hwy 3,RT R Pickering,RYE S.Island Dr,RT E Harstine Island Rd.E.LT Inspiration PT Wy.,LT E
Sylvia
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 that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND D SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION D REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence.Garage,Commercial Bldg,Erc)Manufactured
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole Bldg)El YES(Part(sl of Bldg)0 NO❑
DESCRIBE WORKlnstall manufacutred home on vacant land
SOUARE FOOTAGE:(proposed)
1ST FLOOR1512 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK50 sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached 0 CARPORT sq.ft. Attached❑ Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
mAKE Golden West MODEL Dream Series YEAR2°22 LENGTH27
WIDTH56 BEDROOMS3 BATHS2 SERIAL NUMBER TBD
ENVIRONMENTAL HEALTH: Sw1749 ZZ-dal 31
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER❑ / NEW 0 ISTING❑
PLUMBING IN STRUCTURE? YES D NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOD EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3 t/
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 : •PLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X a (Y/ (3( 2X----
Signature of 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 W — 1b)V h. ? ( 74 I f r -'S C&CILQg:c
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