HomeMy WebLinkAboutBLD2023-01228 - BLD CD Environmental Health Review - 10/11/2023 MASON COUN"I �
ND:�Id2023 -t)IaA8
COMMUNITYTNTCEIVED
Permit Assistance Center, Building,Planning
OCT 11 2023
BUILDING PERMIT APPLICATION
Streel
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Don and Annette Milan NAME: Fit
MAILING ADDRESS:PO Bor 1425 MAILING ADDRESS:
CITY:alyn STATE:WA ZIP:areas CITY: STATE: ZIP:
PHONE#1:3eo-888a52s PHONE: CELL:
PHONE 02:360-990-3318 EMAIL: M O
EMAIL:"beysldeservice.net L&I REG# EXP. /
PRIMARY CONTACT: OWNER p CONTRACrOR❑ DTHBR❑ III
NAME Deem- EMAIL don@bayeldeservica.net
MAILING ADDRESS PO Box 1425 CITY Also STATE WA Zlpaaca 1425 .:
PHONE 3eoaaese2e CELL 36osssas2s
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 22133-32-OMI ZONING Ras
LEGAL DESCRIPTION(Abbreviated) LOT:AM SP N38 S WI13,S&115.S 31/2,S 3818I FIRE DISTRICT 5
SITE ADDRESS 100 E James Or CITy$helton
DIRECTIONS TO SITE ADDRESS WA3 N,Right onto E PkWng Rd,RlgM Wo E Phillips Lake Rd,Len onto Jerett Dr,Right atom Hmaee
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO[D SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (ch koa dmt an*):
SALTWATER❑ LAKE❑ RIVER/Cl ❑ POND ❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION(a ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE iti dem:e,Geroge,Coma.,4sIB/dg, ,.)Residence
IS USE: PRIMARY❑+ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole BW❑ YES(parttj orBlog)❑ NO L,
DESCRIBE WORK Room add8bn off of exlsdng greaHoorn plus uncovered dark expamsbn
SOUARE FOOTAGE: lisvawr0
1ST FLOOR 255 sq.ft. 2ND FLOOR sq.R 3RD FLOOR sq.ft. BASEMENT sq.R
DECK Us sq.ft. COVERED DECK sq.R STORAGE sq.ft. OTHER sq.R
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIALNUMBER
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC EI SEWER❑ / NEW❑ EXISTING 0
PLUMBING IN STRUCTURE? YES ❑+ NO❑ Ijyea,attach completed Water Adequacy Form
PERIMETERNOUNDATION DRAINS PROPOSED? YES❑ NO❑+ EXISTING SQ.FT. U32
EXISTING BEDROOMS 3 PROPOSED BEDROOMS 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 emitted to receive this permit and to do the work as proposed.I have
obtained perniesion from all the necessary parties,including any essement holder or pad"of interest regarding this project, The owner or Nagel
representative,represents that the information provided is accurate and grams employees of Mason County access,to the above described property
and structure(s)for review and inspection. This pernillappiication becomes null 8 void 0 wool,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. INACTMTY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
/T wA- 17- ]� COUNTY CODE 14.08.42) /O/,//2�
X lam^kxl.. {�(.r_11s,�
Signature of OWNER(Must be stoned by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED I DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH iA.S aQd
t 'ua E. Jarrett Drive
gpr Driveway
vi'O a ]7 (n T
C O = M a O
rn r.
Sepik .fin.. 0. p N N
iie.sew.°n O p N
' Esisting House M O y
yo T 5 3 3
c-
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..rtuag a.n arw..od�° C 0
Domed.
P F
14
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EH APPROVED
�pl Rhonda Thompson 11/15/2023
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Ao �R An Milan
nette PLN Approved E r
10/24/2023 Shelto_R, WA 98584
Mason County Community Development Parcel#22133-32-90091
Gavin Scouten
All Changes Subject to Approval
EH Setbacks 5 =Inlet". V rr 40
s
A.1 ept,ienk(s)ervereq F retPsethack4om looGngtlaunaations —
e.)Seplic irequires setback from all loo4ngtlaunaattof
e.7 No foundation/Perimeterd/Rmat Drains within 3gtl,eawngraeient of
Draino Cu Reserve area
D)Nown gradient of Drorihaa5hane over aS degrees)within EH APPROVED
Soh,gown gradient of painlleld'Reserve area
-_eIt I ST'l-vu _ uG a -
Rhonda Thompson 11/15/2023
ISO'