HomeMy WebLinkAboutBLD2024-00279 - BLD CD Environmental Health Review - 3/5/2024 Permit No: l,uL n7�
MASON COUNTY p
COMMUNITY DEVELOPMENT ENV VI HEI� ?AL
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Permit Assistance Center, Building,Planning HE L
BUILDING PERMIT APPLICATION 615 W. MderSteo
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Michelle Vote NAME:
MAILING ADDRESS:851418th Ave NW MAILING ADDRESS:
CITY:Seattle STATE:WA ZIP:98117 CITY: STATE:_ZIR O
PHONE All:206-930-9465 PHONE: CELL:
PHONE#2: EMAIL:
EMAIL:mvote@hotmell.com L&I REG# EXP. / ar
PRIMARY CONTACT: OWNER 0 CONTRACTOR❑ OTHER❑
NAME EMAIL
MAILINGADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 22009-50-00026 ZANINGRR5
LEGAL DESCRIPTION(Abbreviated) CaNCORD VINUMI)1RACTs TR.2 OF m.e a T.L SIMEY WIU FIRE DISTRICT
SITE ADDRESS 5185 E. Picketing Rd. CITYShefton,WA 98584
DIRECTIONS TO SITE ADDRESS N on Hwy 3,R on E Picketing Rd.,L an small driveway,mad before Schneider Rd.between 5271 and 5189,
turn R on gravel drive in approx.259.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO E] SNOW LOAD:25 psf
IS PROPERTY WITHIN 200 FT OFTHE FOLLOWING: (Cheelausavcply):
SALTWATER E) LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND E] SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW 0 ADDITION❑ � ALTERATION ❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE itieslderre,Garage,Caeew,iol Bldg,etc.)New SFR attached garage
IS USE: PRIMARY E] SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS3
HEATED STRUCTURE? YES(Wade Bldg)❑ YES(Part(s1 o/8ldg) a NO❑
DESCRIBE WORK New SFR with attached ga age
SOUARE FOOTAGE: (traparcd)
IST FLOOR 1520 sq.ft. 2ND FLOOR1183 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK376 sq.ft. STORAGE96 sq.ft. OTHER sq.ft.
GARAGE672 sq.ft. Attached❑+ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR _LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC El SEWER / NEWD EXISTINGQ
PLUMBING IN STRUCTURE? YES El NO❑ Ijyes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NO❑ EXISTING SQ.FT.
EXISTING BEDROOMS I PROPOSED BEDROOMS 2 TOTAL BEDROOMS 2
OWNER acknowledges that submission of inaccurate information may result In a stop work order or permit revocatlon. Watowlecigament 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 ft=all the necessary parties,including any easement holder or parties of Interest regarding this project. The owner of legal
representative,represents that the Information providetl is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This permillappl Cadion becomes null&vold g work or authorized construction is not commenced within 180
days or if construction woB 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 Rachel Weber _ 3/1/24
Signature of OWNER(Must be signed by the OWNERI Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH S
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