HomeMy WebLinkAboutBLD2023-00897 - BLD CD Environmental Health Review - 8/11/2023 MASON COUNTY Permit No:BLD�D0-- —00891
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BUILDING PERMIT APPLICATION L Q� 1 r
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PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Henley WA 13 LLC/Tom Roth NAME:Dave Young
MAILING ADDRESS:1537 NW Woodbine Way MAILING ADDRESS:
CITY:Seattle STATE:WA ZIP:98117 CITY: STATE: ZIP:
PHONE#1:206-295-8589 PHONE:360-269-3877 CELL: Rao
PHONE#2: EMAIL:misterdby@gmail.com
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EMAIL: L&I REG#YOUNGD•854CF EXP.03/31/24 AUG 1 1 /}
PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER 0 �u��
NAME LrvedeM iut I Evergreen Pwrnnng and Consulting EMAIL evergreenpermit@gmail.com REC
MAILING ADDRESS 1673 S.Market Blvd.#132 CITY CMhaks STATE WA 71P98532 E�
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PHONE 36os2o-12s1 CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 32021-56-03006 ZONING
LEGAL DESCRIPTION(Abbreviated) Shorecrest Terrace 3rd Add Bik:3 Lot 6 FIRE DISTRICT
SITE ADDRESS 81 E.Panorama Dr CITY Shelton
DIRECTIONS TO SITE ADDRESS North on Hwy 3,ngnt on E Agate Rd,right onto CresMew Dr,turn oft on Panorama Or.&le me be on me left
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❑ LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION❑ REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence.Garage,Commercial Bldg,Etc)Residence
' IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS3 NUMBER OF BATHROOMS2
HEATED STRUCTURE? YES(WholeBldg)0 YES(Part[s]of Bldg)0 NO❑
DESCRIBE WORK New 3 Bedroom SFR
SOUARE FOOTAGE:(proposed)
1ST FLOOR1280 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 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE Imperial Homes MODELTempoSeries YEAR2023 LENGTH48
WIDTH27 BEDROOMS3 BATHS2 SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER❑ / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO 0 If yes.attach completed Water Adequacy Form
PERIMETER/FOUNDATIOls:DRAINS PROPOSED? YES 0 NO0 EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
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 CONTINU ON ORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT AP I N 0 0 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
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Signat e of R(Must be signed by the OWNER) D e
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH 'TJ CtV3 C c `fit t-iis „44C44
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