HomeMy WebLinkAboutBLD2023-01292 - BLD CD Environmental Health Review - 10/31/2023 Permit No:.1 I61 .0d17) - 01,9,0
MASON COUNTY
COMMUNITY DEVELOPMENT
0
Permit Assistance Center,Building,Planning ENVIRONMENTAL
BUILDING PERMIT APPLICATION [4E-AL-T;/=1
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PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: e1
NAME:Virginia Ringseth NAME: OCT 1 2023
MAILING ADDRESS:16822 SE 26th Street MAILING ADDRESS: �J
CITY:Bellevue STATE:WA ZIP:98008 CITY: STATE: ZIP: L
PHONE#1:206-310-9204 PHONE: CELL: RECEIVED
PHONE#2: EMAIL: 07
EMAIL:vringseth@gmail.com L&I REG# EXP. / / /"
PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER 0 CD 0
NAME Virgiwn aingwth EMAIL vingseth@gmail.com —1
MAILING ADDRESS 16822 SE 26th Street CITY 8e1e ue STATE WA ZIP98008 D t in
PHONE 2°6-310-e2a CELL CL -.=- —
PARCEL INFORMATION: --- o `/
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42201-52-00017 RR5 CD W
PARCEL NUMBER(12 Digit Number) ZONING r.
LEGAL DESCRIPTION(Abbreviated)CANAL BEACH TRACTS TR 17&T.L. 18
FIRE DISTRICT (D
SITE ADDRESS25710 N US Highway 101 CITY Hoodsport 9)4.
DIRECTIONS TO SITE ADDRESS MeeEMg Norm on 101,its the first rigid tern off immediately past Glee Ayr.Property Uetween two large tqules,ane We.one groan.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO 0 SNOW LOAD:40 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK❑ POND 0 WETLAND❑ SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION D REPAIR 0 OTHER ❑replacement
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc.)residence
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS 1 NUMBER OF BATHROOMS 1&3A4
HEATED STRUCTURE? YES(Whole Bldg)Q YES(Parv(s4 of Bldg)❑ NO 0
DESCRIBE WORKStick-built home to replace original mobile home and awning plus addition of 2nd floor.
SQUARE FOOTAGE:(p,vposed)
1ST FLOOR698 sq.ft. 2ND FLOOR720 sq.ft. 3RD FLOOR sq.ft. BASEMENT° sq.ft.
DECK200 sq.ft. COVERED DECK sq.ft. STORAGE° sq.ft. OTHER° sq.IL
GARAGE° sq.ft. Attached 0 Detached 0 CARPORT0 sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
W 'H BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER❑ / NEW 0 EXISTING El
PLUMBING IN STRUCTURE? YES 0 NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 1 NOD EXISTING SQ.FT.360
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 1 TOTAL BEDROOMS 1 C/
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 PPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
X CNTY CODE 14.08.42) � � �141k. 0-
gnatur��Must be siby the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH R,CT t L 1z ML3
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