HomeMy WebLinkAboutBLD2023-00854 - BLD CD Environmental Health Review - 7/26/2023 Permit No: 1311 ab9►7) ca)s`7
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'' 7 COMMUNITY DEVELOPMENT •
>. REC • IVAR 62023
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"7 i' 'J Permit Assistance Center, Building,Planning
JUL 1 CEIVED
BUILDING PERMIT APPLICATION ttRM 11NN
PROPERTY OWNER INFORMATION: CONTRACTOR INFO TIO���or Street
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NAME:MACKENZIE STEVENS NAME:T.B.D.
MAILING ADDRESS:P.O. BOX 2137 MAILING ADDRESS: T Do
CITY:SHELTON STATE:WA ZIP:98584 CITY: STATE: ZIP: rr, 0
PHONE#1:360-490-4205 PHONE: ` CELL: > Z
PHONE#2: EMAIL : r �,
EMAIL:MStevens@cfgreens.com L&I REG# EXP. /-/ T1
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PRIMARY CONTACT: OWNER 0 CONTRACTOR ❑ OTHER❑ D
NAME EMAIL r,._
MAILING ADDRESS_ CITY STATE _ ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 220322490010 ZONING RR 5
LEGAL DESCRIPTION(Abbreviated) LOT 1 OF SP#3030 AF#1922454 PTN SE NW FIRE DISTRICT
SITE ADDRESS7590 SE LYNCH RD CITY SHELTON
DIRECTIONS TO SITE ADDRESS SOUTH ON HWY 101, EXIT LEFT LYNCH RD, PARCEL ON RIGHT
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 0 SEASONAL RUNOFF ❑ STREAM ❑
TYPE OF WORK: NEW 0 ADDITION ❑ ALTERATION ❑ REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)NEW RESIDENCE
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS4 NUMBER OF BATHROOMS4
HEATED STRUCTURE? YES (Whole Bldg) ❑ YES (Part[s]of Bldg) 0 NO ❑
DESCRIBE WORK NEW ONE-STORY RESIDENCE W/ATTACHED GARAGE AND BONUS SPACE ABOVE GARAGE
SQUARE FOOTAGE: (proposed)
1ST FLOOR2477 sq.ft. 2ND FLOOR420 sq. ft. 3RD FLOOR sq. ft. BASEMENT sq. ft.
DECK sq. ft. COVERED DECK555 sq. ft. STORAGE sq. ft. OTHER sq.ft.
GARAGE621 sq. ft. Attached 0 Detached❑ CARPORT sq. ft. Attached❑ Detached❑
MAN E INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER ❑ / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO ❑ If yes, attach completed Water Adequacy Form
PERIMEI"ER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ. FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 4 TOTAL BEDROOMS 4
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
/�� �� � COUNTY CODE 14.08.42)
X ' 06-27-23
ISignature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
1 BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL (j /�
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RN .EVISION
N Site Plan _.__zto } Stevens Residence ING-. W.. N . z z 7590 SE Lynch Road . 9';3
p p w ; R R Shelton,WA 98584 I'
"' for Mxkenzle Stevens I v of 1 __. —