HomeMy WebLinkAboutBLD2023-00376 - BLD CD Environmental Health Review - 4/11/2023 �� r'''r`'-gall- MASON COUNTY COMMUNITY SERVICES Permit No: ' 7�
47047
PERMIT ASSISTANCE CENTER: { — `���ddd"
• t'i? •BUILDING••PLANNING••PUBLIC HEALTH••FIRE MARSHAL L.\/
'2. " , 'p 615 W.Alder Street,Shelton,WA 98584 p
�/" Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone ANR 1 0 21=y-'
Lj.`' �Tr Belfair:(360)275-4467•Phone Elma:(360)482-5269
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BUILDING PERMIT APPLICATION 615 W• Alder �tir t
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATIO NV_N V I R O N M El TA L
NAME:Northwest Logging Company NAME:E&G Construction/Ernesto Gonzalez HEALTH
MAILING ADDRESS:2522 N Proctor ST#15 MAILING ADDRESS:291 SE Arcadia Rd
CITY:Tacoma STATE:WA ZIP:9M06 CITY:Shelton STATE:WA ZIP:98584
PHONE#1:253.722.4366-Damon Gustafson PHONE: CELL: 2533270367
PHONE#2: EMAIL:eandgconstruction2020@gmail.com
EMAIL:nwlogging@gmail.com L&I REG#C ycert5G9o'TiIs- EXP., lat l�
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER❑ ' �
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NAME oaonceabe Gustafson EMAIL nwlogging@gmail.com 01 J v
MAILING ADDRESS 2522 N Proctor St#15 CITY T800rt'a STATE WA ZIP984• � �-
PHONE CELL 253.7224366
0
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number)323332200030 ZONING
LEGAL DESCRIPTION(Abbreviated) PCL 2 OF BLA A18-04 AF A2090193 PTN OF GOUT LOT 1 S 4428,S 45/4 FIRE DISTRICT
SITE ADDRESS none my Tahuya
DIRECTIONS TO SITE ADDRESS From Belfair NE Clifton Ln turn onto Belfair Tahuya Rd,follow to Dewatto Bay Rd/NE Dewatto Holly Rd
turn right,follow to NE North Shore Rd turn left,Follow for about.75 miles driveway up hill is on your left(across from black fence.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES.❑ NO 0 SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW e ADDITION 0 ALTERATION 0 REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc.)Residence
41 IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS3 NUMBER OF BATHROOMS2
HEATED STRUCTURE? YES(Whole Bldg) .❑ YES(Part(sf of Bldg)0 NO 0
DESCRIBE WORK
SQUARE FOOTAGE:(proposed)
1ST FLOOR 1,97E sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft.. COVERED DECK132 • sq.ft. STORAGE sq.ft. OTHER160 ,sq.ft.
GARAGE900 sq.ft. Attached❑ Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HnMF INFO RMAIlON: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAK MODEL YEAR LENGTH
DTH BEDROOMS BATHS SE iJd48FR
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC Q SEWER e / NEW Q EXISTING 0
PLUMBING IN STRUCTURE? YES❑ NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES I/ NOD EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
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.
PROOF OF CONTINUATIO OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT ti ION 180 D OREWILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
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 (� j�j /�
PUBLIC HEALTH '✓ /f $ (o 1(4(t175 a*"
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