HomeMy WebLinkAboutBLD2023-00838 - BLD CD Environmental Health Review - 7/23/2023 DocuSign Envelope ID:5C1E8025-73B7-4398-B638-18458E510264
�or.` ri'1,.1� MASON COUNTY COMMUNITY SERVICES Permit No: ,Lb .0 -3 0638
i`�Cimi •. PERMIT ASSISTANCE CENTER: y
y "< -BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL RE C E 1;r E E)
615 W.Alder Street,Shelton,WA 98584 VVV
f .q Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone ATM/IRON M E N TA L
BeBak:r6.::)275-4467•Phone Elmo:(360)482-5269
`�*` BUILDING PERMIT APPLICATION 615 W. Alder_ 6t
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: aC= /
NAME: Jacob Kenndy NAE:SOUTH SHORE MAILING ADDRESS:e200 E Rasor Lane MAILING ADDRESS:PO BOX 9pCTION INC JUL 2 b•CO2
CITY:Belfalr STATE:WA ZIP:��,528 CITY:BELFAIR STATE:WA ZIP:98528 3
PHONE#1: 360-265-5101 PHONE:360 275 0818 CELL: R�CE�VE�
PHONE#2: EMAIL:southshoreLdiq.com
EMAIL: L&I REG# SOUTHSC016NL EXP. 02/10/24
PRIMARY CONTACT: OWNER❑ CONTRACTOR[� OTHER❑
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 12207-75-0041 O ZONING R R 5
LEGAL DESCRIPTION(Abbreviated) TR 41 OF SURVEY 5/94-96 FIRE DISTRICT
SITE ADDRESS 200 E Rasor Lane cITY Belfair
DIRECTIONS TO SITE ADDRESSTake Highway 3 towards Belfair.Turn left onto Highway 106.Turn left onto E Rasor Rd.
Turn left onto E Rasor Ln. On the right, "200 E Rasor Ln" is written on a blue sign on a wooden fence
-Call ahead so owner can lock up do
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO f SNOW LOAD: 25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all Mar apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW cel ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.)
IS USE: PRIMARY V SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 1
HEATED STRUCTURE? YES(Whole Bldg)❑ YES 8'a,14ofBldg),V NO❑
DESCRIBE WORK Install new manufactured home for residential use
SOUARE FOOTAGE: (proposed)
1ST FLOOR 972 sq.R 2ND FLOOR_ sq.ft. 3RD FLOOR sq.ft. BASEMENT._ sq.ft.
DECK sq.R COVERED DECK sq.ft. 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 KIT MODELCedar Canyon 2055-LS YEAR 2023 LENGTH 36
WIDTH 27 BEDROOMS 2 BATHS 1 SERIAL NUMBER N/A
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC V SEWER❑ / NEW V EXISTING❑
PLUMBING IN STRUCTURE? YES V NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ N EXISTING SQ.FT. ./EXISTING BEDROOMS 0 PROPOSED BEDROOMS 2 V - TOTAL BEDROOMS 2
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.AcknonAedgement of such is by
signature below.I dedare 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 APPUCATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
�^ 7/11/2023
i(„t. e
-Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH ((( ( 3rANd (,t s It
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