HomeMy WebLinkAboutBLD2022-00818 Seasonal SFR - BLD Application - 6/27/2002 MASON COUNTY COMMUNITY SERVICES Permit No: Z- Q)I e
PERMIT ASSISTANCE CENTER: D
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL RECEIVE
615 W.Alder Street,Shelton,WA 98584
Phone Shelton:(360)427-9670 ext.352•Fax(360)427-7798 Phone J U N 2 7 2022
Balfair.(360)2754467•Phone Elmer:(360)482-5269
BUILDING PERMIT APPLICATION 615 W. Alripr reet
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Jeff&Sabrina Scott NAME:Lexar Homes
MAILING ADDRESS:815 29th Ave E MAILING ADDRESS:1213 Long Rd
CITY:Seattle STATE:WA 2IP:98112 CITY:Centralia STATE:WA ZIP:98531
PHONE#1:206-713-3195 PHONE:360-807-1849 CELL: 360-669-6858 Z
PHONE#2:206-245-9259 EMAIL:srobinson@lexarhomes.com _
EMAIL.:jeffwscott@mac.com/sabdnassoott@gmail.com L&I REG#LEXARH-86205 ExP.6/3p/2022
PRIMARY CONTACT: OWNER I] CONTRACTOR❑ OTHER❑
NAME EMAIL J
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 12119-53-00080 ZONING ca
LEGAL DESCRIPTION(Abbreviated)HARTSTENE POINTE#4 LOT:80,S 47/208 FIRE DISTRICT
SITE ADDRESS568 E Pointes Dr W CITY Shelton,WA 98584
DIRECTIONS TO SITE ADDRESS Continue on 1-5 N.Take US-101 N to WA-3 N in Mason County.Take the WA-3 N exit from US-101 N
Follow WA-3 N,E Pickering Rd and E North Island Dr to E Poinles Dr W.The destination will be on the right.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO E] SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW E] ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Foe.)
IS USE: PRIMARY❑ SEASONAL O NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES lwholeBldg)❑� YES(Part[j]of Bldg)❑ NO❑
DESCRIBE WORKI 'n
SQUARE FOOTAGE:(propos4
1 ST FLOOR. _sq.ft. 2ND FLOOR_ _sq.ft. 3RD FLOOR sq.fL BASEMENT sq.ft
DECK sq.ft. COVERED DECK_ _sq.R. STORAGE sq.ft. OTHER sq.ft.
GARAGE360 sq.ft. Attached❑ Detached CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED-
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER / NEW(] EXISTING
PLUMBING IN STRUCTURE? YES❑+ NO❑ If yes,attach completed Water Adequacy Form
PERIMETERNOUNDATION DRAINS PROPOSED? YES❑ NO❑� 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 pernitlapplication 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)
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Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NQTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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DRAWN BY:
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PROJECT#
GI J/1aa• $'$ i�rAA56403702
THE PROPERTY LINE5 IN TH15 MAP PRINT DATE:
ARE APPROXIMATE AND ARE NOT 520/2022
INTENDED TO BE U5ED A5 5URVEY. SHEET.
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