HomeMy WebLinkAboutBLD2023-01285 - BLD CD Environmental Health Review - 10/24/2023 Permit Noketiitt5
r . � MASON COUNTY
`� .- COMMUNITY DEVELOPMENT
OCT 23 2023
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: Paul Jensen NAME: n F.n
MAILING ADDRESS:51 Skylark Ct E MAILING ADDRESS: ;p 2 'a
2
CITY:Allyn STATE:WA ZIP: 98524 CITY: STATE: ZIP: R1 a
PHONE#1:971-600-1302 PHONE: CELL: m g
PHONE#2:971-600-1007 EMAIL: 2
EMAIL: servumdomini@gmail.som L&1 REG# EXP.—
PRIMARY CONTACT: OWNER 0 CONTRACTOR❑ OTHER 0
NAME Paul Jensen EMAIL same as owner
MAILING ADDRESS same as above owner CITY STATE ZIP =
PHONE CELL 971.9041302
2
PARCEL INFORMATION: i
PARCEL NUMBER(12 Digit Number) 122085102015 ZONING Rural Res 20 ->
LEGAL DESCRIPTION(Abbreviated) Lakewood Plat.1 blk 2 lots lot 5 Belwood FIRE DISTRICT r
SITE ADDRESS 51 Skylark Ct.E CITY Allyn
DIRECTIONS TO SITE ADDRESS Rt 3 to SR 302 intersection,East to Belwood Estates
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 all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW❑ ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.De.) Residence
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS2 '
HEATED STRUCTURE'? YES(Whole Bldg)0 YES(Parr/s/q/Bldg)❑ NO❑
DESCRIBE WORK Addition of a living space(den/office)in rear of existing home,slab on grade (lfess than 260 sq ft
SOUARE FOOTAGE: (proposed)
1ST FLOOVIIr2 ID sq.ft. 2ND FLOOR° sq.ft. 3RD FLOOR° sq.ft. BASEMENT° sq.ft.
DECK0 sq.ft. COVERED DECK° sq.ft. STORAGE° sq.ft. OTHER° sq.ft.
GARAGE° _sq.ft. Attached 0 Detached❑ CARPORT° sq.ft. Attached 0 Detached❑
MANUFAC • *4 COPIES OF THE FLOOR PLAN REQUIRE
MA MODEL R LENGTH
• IDTH BEDROOMS BATHS SERIAL NUM K
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER 0 / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO❑ Ifyes.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.
EXISTING BEDROOMS 3 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 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,induding 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) 1
X I0-2. -2, �
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 A(VJ C._rN a }IIl klL.c t5, ,
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