HomeMy WebLinkAboutBLD2024-00344 - BLD CD Environmental Health Review - 3/18/2024 � Permi(.�pi -�3r��'
MASON COUNTY FCC
COMMUNITY DEVELOPMENT MAR 13 2024
Permit Assistance Center, Building,Planning5 w. Afl{er Str6�t
BUILDING PERMIT APPLICATION ,C,,, }/V\
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: r
NAME:Bob Thompson NAME: C
MAILING ADDRESS:250 W. Ayock Beach Dr. MAILING ADDRESS: - 2
CITY:Lilliwaup STATE:WA ZIP:98555 CITY: rn z
PHONE#I:360-269-7982 PHONE: CELL:
PHONE#2: EMAIL:
EMAIL:byrdthompson@gmail.com L&I RE G# EXP._/_/ -- Z
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER 0
NAME Len Williams WilliamS Architecture EMAIL Ie0 williams-architecture.com ,
MAILING ADDRESS PO BOX 102 CITY SHELTON STATE WA P985
PHONE 360-426-0511 CELL
PARCEL INFORMATION: B ?4
PARCEL NUMBER(12 Digit Number) 32303-50-01 01 1 ZONINGRR5 REC
LEGAL DESCRIPTION(Abbreviated) Ayock Beach ELK: 1 Lot: 11 EX 11-A FIRE DISTRICT
SITE ADDRESS 260 N. Ayock Beach Dr. CITY Lilliwaup
DIRECTIONS TO SITE ADDRESS From Shelton, take US HWY101 N. Right on N. Pebble Beach Dr.
Right on N. Ayock Beach Dr. Site is on Left
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO I] SNOW LOAD:4�sf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checkattihmapply):
SALTWATER❑+ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑+ ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER ❑+ REPLACEMENT
USE OF STRUCTURE(Ruldeem Geroge,Commercial B/dg,Etc.)Residence
IS USE: PRIMARY E] SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 4-1/2
HEATED STRUCTURE? YES(whole Bldg) ❑+ YES(Par'111 ojBldg) ❑ NO rG
DESCRIBE WORK Remove and replace existing residence. IYL4r LdpC,l 26OE -24 E
SOUARE FOOTAGE: (propenug
1ST FLOOR 2168 sq.ft 2ND FLOOR 1064 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK 371 sq.ft. COVERED DECK 385 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
mt� ME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL EAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC D' SEWER❑ / NEW❑+ EXISTING❑
PLUMBING IN STRUCTURE? YES ❑' NO ❑ Ijyes, attach completed Water Adequacy Form
PERIMETERIFOUNDATION DRAINS PROPOSED? YES ❑+ ND[] EXISTING SQ.FT. 1396
EXISTING BEDROOMS 2 PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
OWNER acknowledges that submission of inaccurate information may result in a atop work order or permit revocation.Admowledgement 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 met the Information provided is accurate and grants employees of Mason County access to the above descd bad property
add structure(s)for review and inspection. This permiVapplication becomes null 8 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
NTY CODE 14.08.42)
X ��Yr// 3-13-24
Signature of agent Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH 4Z.Q�,-C10 I o3
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