HomeMy WebLinkAboutBLD2024-00304 - BLD CD Environmental Health Review - 3/8/2024 MASON COUNTY Permit No:
COMMUNITY DEVELOPN92MIV
Permit Assistance Center, Building,Planning MAR U 6 20Q2 p
BUILDING PERMIT APPLICATION ca
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: rn
NAME:Henley WA i]LLC NAME:Dave Young
753T NW Woodbine Way MAILING ADDRESS: r
MAILING ADDRESS: STATE: ZIP.
CITY:Seattle STATE:WA ZIP:981n CITY:
PHONE#1: PHONE: CELL: :
PHONE#2: EMAIL: 1
03/_
EMAIL: L&I REG#YOUNOD•as4CF EXP.
PRIMARY CONTACT: OWNER[] CONTRACTOR[] OTHERO+ [ ,T
NAME LPP""'a""-�re"e1eii a""w"° EMAIL permits@iurergeserpermilding.win
MAILINGADDRESS 1613S.Medcetelvd,#132 CITY Chews STATE WA ZIP9e5
PHONE s°0'S16151 CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 31904S5-00041 ZONING
LEGAL DESCRIPTION(Abbreviated) FAWN LAKE#6 TR.41 FIRE DISTRICT
SITE ADDRESSa1 SE Azalea PI CITYSWW
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPES)GREATER THAN 14%: YES[] NO❑ SNOW LOAD:3L—Psf
IS PROPERTY WITHIN 200 PT OF THE FOLLOWING: (Check air dmr appil
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW E+ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER Q+
USE OF STRUCTURE(Ir ekh -,,Gang-.CammenblBl4g,Em.)Ri siren
ISUSE: PRIMARY Q+ SEASONAL❑ NUMBER OF BEDROOM53 NUMSEROFBATHROOMS?
HEATED STRUCTURE? YES(note Bldg)Er YES(Pan(e1 ofB/dg)❑ NO❑
DESCRIBE WORKNew 3 bedroom mig home
SQUARE FOOTAGE: (rnpaeea
IST FLOOR12W sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.fL BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLOOR PLAN REQUIRED"
MAKElmwrial Homes MODELTampo Series YEAR2024 LENGTH !
WIDTH27 BEDROOM53 BATHS2 SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC[I SEWER[I / NEW E+ EXISTING
PLUMBING IN STRUCTURE? YES 0+ NO❑ If yes,attach completed Water Adequacy Form
PERMTER/FOUNDATION DRAINS PROPOSED? YES❑ NOR EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 TOTAL BEDROOMS
OWNER ackpowledgea met submission of inaccurate information may result In a atop work order or permit relocation.A knowledgernent of such Is by
signature below.I detlare that 1 am me owner and I further declare that I am entitled to receive this perms and to do the work as proposed.I have
obtained pemlisslon from all the necessary parties,Indudlng any easement holder or paimes of Interest regarding this project. The owrar or legal
representative, represents inet the Information provided Is accurate act grants employees at Mason County access to the above described primary
and simcture(s)for review and Inspection. This pemni rapplkation becomes null S void if work or authorized oonslruction Is not commenced Wthln 180
days or If construction work Is suspended for a perod of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATI•y OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42) 3)�Id l
X Date Signature
Signature of ER(Must b alone_by the OWNERI
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITTONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH n " I y
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