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HomeMy WebLinkAboutBLD2023-01296 - BLD CD Environmental Health Review - 10/31/2023 DocuSign Envelope ID: 136A9A27-F7OF4390-9DOC-97DCB7F4C636 Permit No: (�J�� a�l- D f a( (p MASON COUNTY COMMUNITY DEVELOPMENT Permit Assistance Center, Building,Planning o z BUILDING PERMIT APPLICATION m f R PROPERTY OWNER INFORMATION• CONTRACTOR INFORMATION• o NA-W: Peter Jones&Lora Ann Duvall-Jones NA S4E:NW Construction Cooperative MAILING ADDRESS:260771 MAILING ADDRESS: P.O. Box 2953 CITY:South Riding STATE:vA ZIP:20152 CjTY:Olympia STATE:WA ZIP:98W7 PHONE #I: PHONE:380.754.354+ CELL: PHONE#2: EMAIL :info®nonhwestoonsauction.cocp EMAIL: L&j REG#NORTHCC86OND EXP. 08/04/24 PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER NAME Jason Teelllaus coo.Amsana cmup Amhiledum 8 piannim EMAIL lason0anlsansgroup.com MAILING ADDRESS 6504 capitol BNd Se CITY Tumwater STATE WA ZIP sa5o+ PHONE 20s.e3e.7osa CELL 206.639.7095 Z PARCEL INFORMATION: it PARCEL NUMBER(12 Digit Number) 22029-77-50030 ZONING RR5 P' LEGAL DESCRIPTION(Abbreviated) TR 3 OF S 21103 u.S#96-0003 PTN NW NE FIRE DISTRICT Mason County#4 SITE ADDRESS 260 SE Valhalla Ln CITY Shelton DIRECTIONS TO SITE ADDRESS Fmm Shelbn-Scum on olympla Hwy S>Lelr m E Ammdk Ave>In e.a mraa,pdmw read b on the IM(SE V#heae Ln)>Parml N on me,t m IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESD NO ❑ SNOW LOAD:25 psf 70 IS PROPERTY WITHIN 20O FT OF THE FOLLOWING: (Check an that apply): M SALTWATER ❑ LAKE ❑ RIVER/CREEK ❑ POND ❑ WETLAND ❑ SEASONAL RUNOFF ❑ STREAM ❑ l..a m TYPE OF WORK: NEW ® ADDITION ❑ ALTERATION ❑ REPAIR ❑ OTHER ❑ o USE OF STRUCTURE (Residence, Garage, Commercial Bldg,Eta.) Residence w/attached garage. "' M IS USE: PRIMARY ❑+ SEASONAL ❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 3 HEATED STRUCTURE? YES (Whole Bldg) ❑ YES (Parl[s]ofBldg) Q NO ❑ DESCRIBE WORK Now SFR w/attached unheated garage. SOUARE FOOTAGE: (proposed) I ST FLOOR 1813 sq. ft. 2ND FLOOR 727 sq. ft. 3RD FLOOR sq. ft. BASEMENT sq. ft. DECK sq. ft. COVERED DECK CJ_sq. ft. STORAGE sq. ft. OTHER sq. ft. GARAGE 742 sq. ft. Attached 0 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 v❑ NO ❑ Ijyes, attach completed Water Adequacy Form PERIMETER/FOUNDATION 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 permit/application 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 ICI COUNTY CODE 14.08.42) I o cu5lamdW:lamdW:} , MylA 10/24/2023 —C-1$4Mkq@41H2OWNER (Must be signed by the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSINOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH � �// § � | u ■ | ( §\i� <�. a / - ■ EEzU ` � § � © \ \ - \ ■§ . . � , \ \$ � a7' ! :. • - - - - �.- - - - - - - - - - � - - - « a=.- - - - - T ! \ � a 0 ¢$ � » ® °411, ` ~ } \ A � « \ | ` » % ( ! \ \ 6-5 ~ r - - - - —- - - - - - - - - - �z /] E�E.—_. $ /H .ANS 2 � � | � &— �- -- �=_ --