HomeMy WebLinkAboutBLD2024-00123 - BLD CD Environmental Health Review - 1/31/2024 1 la
PROPERTY OWNER INFORMATION: CONTRACTOR INFO
NAME:Soot and Wendy Weldy NAME:Armstrong homes oferemenon JAN 29 2024
MAILING ADDRESS:set I Ift A"SN MAILING ADDRESS:201 Pan,Aro
CITY:sseme STATE:wA Z(p;ga1a8 CITY:erenr.mn She{ ^
PHONE#1:3so5 1745 PHONE:380-37 081 CELL: 353-797U211
PHONE#2: EMAIL :oaaastogiw.ao.mm
EMAII.:erewaklye®yahoo.com L&I REG#ARMST1-11330701 EXP. 05/025
PRIMARY CONTACT: OWNER❑ CONTRACTOR 0 OTHER
NAME sue' ual�y EMAIL
MAILING ADDRESS IyaryWng same as abova CITY STATE_ ZIP
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PHONE CELL
PARCEL INFORMATION: _
PARCEL NUMBER(12 Digit Number) 1213133-0 10 TONING s
LEGAL DESCRIPTION(Abbreviated) Rage:11AFT-91hip:20N section:31 FIRE DI CT
SITE ADDRESS 151 E Camus Draw. CITY Shelton
DIRECTIONS TO SITE ADDRESS A
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESD NO[] S P
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checkeliduriap,*):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ S
TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Besldenos,Garage,C--,,,lal Bldg,Ent.) d=
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 3
HEATED STRUCTURE? YES(whote Borg)0 YES(Pan[,j yBldg)❑ NO❑
DESCRIBE WORK New raskental consbumon single famay dealing
SOUARE FOOTAGE: (Grovosadi
1ST FLOOR853 OR1zzt sq.III. 3RD FLOOR sq.ft. BASEMENT sq.fL
DECK egg-2r sq.ft. COVERED DECK sq.R STORAGE sq.ft. OTHER sq.R
GARAGE sir sq.R Attached 0 Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH fV
WIDTH BEDROOMS BATHS SERIAL,NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER❑ / NEW 0 EXISTING❑
PLUMBING IN STRUCTURE? YES 0 NO❑ Ijyes, attach completed Water Adequacy Form 1
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 2 TOTAL BEDROOMS 2
OWNER acknowledges that submission of Inaccurate information may result in a slop 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 p ifnit and to do the work as proposed.I haw
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this projed. 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 permitlapplication becomes null g wid if work or authorized construction a not commenced within 180
days or 8 construction work a 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)
XStaCy Mallory laai) ele2D2 . 010. :5
Signature of OWNER(Must be signed by the OWNER) Date
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