HomeMy WebLinkAboutBLD2023-01212 - BLD CD Environmental Health Review - 10/10/2023 MASON COUNTY Permit No:P31. Q3-Dl2/2
COMMUNITY DEVELOPMFa% M3L
k COy1� Permit Assistance Center, Building,Planning AW
BUILDING PERMIT APPLICATION 615 W.
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: OCT 1 O 023
NAME:William Giese NAME:IL MAING ADDRESS:221 HE Haven Lake DR MAILING ADDRESS:
CITY:Tahuys STATE:WA ZIP:9` 5 CITY: STATE:_ZIP:
PHONE#1:(3W)801-8085 PHONE! CELL:
PHONE#2:(360)2756213 EMAIL:
EMAIL:brglese®Mhreil.mm L&I REG# ERP._/ /
PRIMARY CONTACT: OWNER❑+ CONTRACTOR❑ OTHER❑
NAME ms""aa°° EMAIL bgiese,@hotmail.com
MAILING ADDRESS 221 HE Hewn lake DR CITY T^ - STATE WA ZIPS
PHONE taTusean CELL I160t01r'
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) MiGgZ0"00288 ZONINGRural Residsnoal 5 Acres
LEGAL DESCRIPTION(Abbreviatad) HAVEN LAKE TR 299 FIRE DISTRICTNMWA
SITE ADDRESS 180 HE Haven lake DR CTIYTa"
DIRECTIONS TO SITE ADDRESS r e"u"''sv ma"ea'w*aonwoa mtnm rwawurw waotat poOwrmwaeHora eiv.aao.t m,n.n nos
onto NEBegakTah,"Rd4.0mi, Turn rightonto HE Haven Way 1.5ml,Tun leftonto HE Haven Lake Dr0.6 ml sitam leftakMmRd.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO j@ SNOW LOAD:
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (cn x m 0arapAly):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW p ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Redeem Gmalm Come 1114,Ex.) RasH"aw
IS USE: PRIMARY Q SEASONAL❑ NUMBER OF BEDROOMS2 NUMBER OF BATHROOMS2
HEATED STRUCTURE? YES(n kaki,)❑+ YES(ftr4do/Bty❑ NO❑ (1
DESCRIBE WORKlnstell of 1986 Manufactured Horns
t COUARE FOOTAGE: (ar p o
rD
FLOOR sq.R 2ND FLOOR sq.ft 3RD FLOOR sq.0. BASEMENT sq.fL
sq.R COVERED DECK sq.IL STORAGE sq.R OTHER sq.1L
sq.R Attached❑ Detached❑ CARPORT sq.R Attached❑ Detached❑
ACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
acor MODEL27/56 YEARIW6 LENGTH7 BEDROOM32 BATHS2 SERIAL NUMBER0330ONMENTAL EMALTH:
JSEWER SOURCE: SEPTIC Q SEWER❑ / NEW❑' EXISTINGG IN STRUCTURE? YES❑+ NO❑ IJyes,attach completed Water Adequacy FormER/FOUNDATION DRAINS PROPOSED? YES❑ NOO EXISTINGSQ.FT.EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
OWNER ackrowledges that submission of inaccurate information may rai in a a"work order or Permit revocation.AcknaMadgementof such b by
sigrebre below.I declare that I am the owner and I fuller declare that I am entitled W receive N the work as proposed.I haveis permit and to do
obtained permiss on from all me necessary parties,induding any easement holder or parties of interest regarding Nis pmjea The otwrer or legal
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