HomeMy WebLinkAboutBLD2023-01083 - BLD CD Environmental Health Review - 9/12/2023 MASON COUNTY Pertn(tNa:�i jtA 0l063
COMMUNITY DEVELOPMENT RECEIVED z
Permit Assistance Center,Building,Planning CEP 1 i. 2on C
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: 615 W. Aid r StT3� Ozz
NAME:MKXIAELA JESSAMYN HEYMMN NAME:FUTURE HOME SERVICES MC
MAILING ADDRESS:m NE LARSON LAKE RD MAILING ADDRESS:PO BOX 2SU3 = M
CITy:BELFAIR STATE.WA ZIP:985M CITY:GIO HARBOR STATEMA ZIP:98335 Z
PHONE#I: PHONE:(300)9069TA CELL: D
PHONE 42: EMAIL aNieNlNulanomeabremertan.can r
EMAIL: LBI REG#FUTURHST`WDO EXP. 71
PRIMARY CONTACT: OWNER❑ CONTRACTOR El OTHER Q --- LS W
NAMEANDIEAMIDOtlt H EMAIL an Ie(IAlhllBtlCr11BSMBRIedM.CN11 _
PCULINGHONE ADDRESS
PO 60)Ill BOX 2503 CELL CMGIGHARBOR STATE WA ZIPBE395 SEP 1 22023 _
PARCEL INFORMATION: RECEIVED
PARCE1,NUMBER(12DigtNuanba)12331-51-DW51 ZONING
LEGAL DESCRIPTION(Abbn,,ae,)BEARDS COVE DIV 8 WT 5e FIRE DISTRICT
SITEADDRESS280NELMSONL/a11E RD CITYBELFAIR _
DIRECTIONS TO SITE ADDRESS BI to.0 S{C ph&p —
ISTHEPRO.IECTWRHIN300FTft�OFSLOPE(S)GREATERTHAN14%: YES[] NOB SNOWLOAll
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: ITLkdahhayalaa,.
SALT WATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM B
TYPE OF WORK: NEW B+ ADDITION❑ ALTERATION❑ REPAIR D OTHER fl DEW OLD
USE OF STRUCTURE(RrMm.c GhaV, aaanmW,,y&fiat SFF
ISUSE: PRIMARYB SEASONAL[] NUMBEROFBEDROOMS 2 NUMBEROFBATHROOMS 2
HEATED STRUCTURE! YES(m B aS EI YES rymr/,l B.W❑ NO❑
DESCRIBE WORK DEW 8 REPLACEMENT OF MANUFACTURED HOME
SQUARE FOOTAGE:IP^Aaa�l
1STFLOOR I29E sq.8. 2NDFLOOR aq.fi. 3RDFLOOR N.ft BASEMENT eq.R.
DECK aq.B. COVERED DECK N.B. STORAGE sq.R OTHER q.A.
GARAGE 'q It Aal o DatacJm o CARPORT aq.R AtwyledO Dal t3
MANUFACTURED ROME INFORMATION: e1 COPIES OF THE FLOOR PLAN REQUIRED•
(,TAKE SANDPOINTE MODEL 2EA82A YEAR 2IN3 LENOl
WIDTH 2T BEDROOMS 2 BATHS 2 SERIALN,MBER TBD
ENVIRONMENTAL HEALTH:
SEWAGE/SEWM SOURCE: SEPTTCQ SEWER❑ / NEW EXISTING
PLUMBING M STRUCTURE? YES a NO❑ /Jyu,M•-^h Ca 111a W.Adequacy F.-
PERIMETER/FOUNDATION DRAMS PROPOSED? YES❑ NOB EXISrINGSQFT.
MSTINGBEDROOMS PROPOSED BEDROOMS 2 TOTAL BEDROOMS 2
OWNER acknoMetlgea Inal suLmiss'nn dinaazlM IM that.may result In a slop walk untaw pamN revcwtlm.A anaAeEpemeM d al is a/
wrialure otlow.l tletlare Nn I am Me amm sM I NMar O hn Nal l amanllt.torecNve this yehna and IO OO Na..papfM.I Mse
onlamatl permission Iran all the
ns easery pNes,iMubnp any eaaemenl hl m panes W In1ereR rsyarning Nis projel Tie wlsrclpel
repe¢eMetive,lepeaenls Ihe1Me InlortnaYm pmnEM'a eau2h mtl Blenb englDytts of Masm County aaas to Ne aEon aeglM]gywly
dngordun(a)Iorl wol inEinspediedfwa nNap(AMatim GemmeanW BvdE RxoMmwNarseE anaLurnmYmlmmmxvOvtlNin IRO
tlaya or I mnwurtion woM1 Is aspenEeE fm a peno0 d IBO Eays.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT 15 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 7orrma./.Ya�(pitr:1ld'! 09-08-2023
Si[reared ER IM7iat slanedbrthe OWNEM Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH (.
Larson Lake Rd
78'
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