HomeMy WebLinkAboutBLD2023-01213 - BLD CD Environmental Health Review - 11/13/2023 rL
`� Ltiti(t MASON COUNTY COMMUNITY SERVIC r �o/• Ot a3 0 /9-1
PERMIT ASSISTANCE CENTER: r E �� V J
• •BUILDING•PLANNING•PUBLIC HEALTH.FIRE MARSHAL
"1 t' j 615 W.Alder Street,Shelton,WA 98584
Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone O C T -9 2023 ENVIRONMENTAL
y� y Bel(air(360)275-4467•Phone Elma:(360)482-5269
BUILDING PERMIT APPbtlkibWkIder Street HEALTH
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:JOE & KRISTIE BERG NAME:PHIL STUEN, DEPHIANCE DESIGN-BL
MAILING ADDRESS:9831 MARINE VIEW DR S% MAILING ADDRESS:5310 N HIGHLAND ST
CITY:SEATTLE STATE:WA ZIP:98126 CITY:RUSTON STATE:WA ZIP:98407
PHONE#1:206.724.2136 PHONE:253.225.8587 CELL: NOV 1 3 2023
PHONE#2: EMAIL:phil@dephiancedb.com
EMAIL:kristieberq@hotmail.com/jeb@slalom.c L&I REG#DEPHIDB824D1 EXP. 03/,Q1/24
RECEIVED
PRIMARY CONTACT: OWNER❑ CONTRACTOR 0 OTHER 0
NAME TODD SMITH EMAIL toddsmith@syndicatesmith.com
MAILING ADDRESS 220 US HIGHWAY 2 CITY LE_AVENWORTTATE WA 7IP98826
PHONE 509.670.3130 CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 1 21 05-52-001 1 2 ZONING RR5
LEGAL DESCRIPTION(Abbreviated) TREASURE ISLAND TR 112 &T.L. , S FIRE DISTRICT3
sITE ADDRESS 930 E TREASURE ISLAND DRIVE, ALLYN, WA 9852,crryALLYN
DIRECTIONS TO SITE ADDRESS From W Pine St& N 2nd St in Shelton, head east on Pine St(1.7 mi), c
Turn left to stay on E Grapeview Loop Rd (1.0 mi),Turn right onto Treasure Island Rd (0.4 mi), sligY
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO❑ SNOW LOAD:25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER E LAKE 0 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.Commercial Bldg Etc)RESIDENCE WITH ATTACHED GARAGE AND COVE
IS USE: PRIMARY❑ SEASONAL 0 NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 4
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Part(.,)of Bldg)E NO❑
DESCRIBE WORK NEW CONSTRUCTION 3 BEDROOM 4 BATH RESIDENCE WITH ATTACHED GAE
SQUARE FOOTAGE: (proposed)
1ST FLOOR 2,017 sq.ft. 2ND FLOOR 2089 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK 612 -sq.ft. COVERED DECK 1260 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE 512 sq.ft. Attached(] Detached❑ CARPORT sq.ft. Attached 0 Detached D
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE N/A MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER❑ / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES E NO 0 yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO❑D EXISTING SQ.FT. 0
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 3 L 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 OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
�` COUNTY CODE 14.08.42)
X x 10/6/23
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
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