HomeMy WebLinkAboutBLD2023-01210 - BLD CD Environmental Health Review - 10/6/2023 MASON COUNTY Permit No: Ft119 13—OId4O Z
. • ; COMMUNITY DEVELOPMEN11 ECEIVED
Permit Assistance Center, Building,Planning OCT 0 6 2023 Z
BUILDING PERMIT APPLICATION 615 W.Ader Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Amelia 1 LLC NAME:DaVe Young Z
MAILING ADDRESS:1537 NW Woodbine Way j MAILING ADDRESS:
CITY:Seattle STATE:WA ZiP:98177 ! CITY: STATE: ZIP: D,
PHONE#1: PHONE: CELL: I—
PHONE#2: EMAIL:
EMAIL: L&I REG#YOUNGD*854CF EXP.03/31/24
PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER 0
NAME Lowe•Nhvlck/Ewgwn P•m•anq a Pwmi ng EMAIL evergreenpemstegmait.com
MAILING ADDRESS 1673 S.Market Blvd,#132 CITY chwN STATE WA ZIP98e532
PHONE "2°'m2s1 CELL M(-L�
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number)32021-53434047 ZONING O C T 4 9 2023
LEGAL DESCRIPTION(Abbreviated)SHORECREST ADD REPLAT FIRE DISTRICT
SITE ADDRESS0 E Bridger Ln CITY Shelton RECEIVED
DIRECTIONS TO SITE ADDRESS North on WA-3.right on E Agate Rd,light on Crestview.left on E Bridger Ln,site will be on the right
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO 0 SNOW LOAD:25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check al that applv):
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION 0 REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence.Garage.Cenrmerrial Bldg.Etc)Resdence
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS3 NUMBER OF BATHROOMS2
HEATED STRUCTURE? YES(Whale Bldg)0 YES(Parr/s)of Bldg)0 NO❑
DESCRIBE WORK Now 3 Bedroom Mfg Home
SQUARE 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 MODEL Tempo series YEAR2023 LENGTH48
WIDTH27 BEDROOMS3 BATHS2 SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER 0 / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO 0 lfyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOR* 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 CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION 80 •AYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X / /0 j23
Signature of•WN • (Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL 4 J n J�_ n
PUBLIC HEALTH (( 3 l.ra�f0t a
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