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HomeMy WebLinkAboutBLD2023-01387 - BLD CD Environmental Health Review - 11/16/2023 Docu5lgn Envelope ID:090]DA01-91EHOE9-90a0-A04]]9]DDC3E !� PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: V�/��A�+3•U NAME: Rod:Holdings LLC NAME:Fuame domes of T a r— MAIIJNGADDRESS: POBOX88110 MAILING ADDRESS:acomhSt ue'C CITY: Seattle STATE: wA ZIP: salsa CITY:Tacoma STATE:WA ZIP:984" PHONE#1: 253599S323 PHONE:253-MI3e00 CELL: PHONE#2: EMAIL EMAIL: L&I REG# 604951885 EXP._/_/—f1 Q Z PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHERS NAME Crystal Mattson-Mattson Land Consujtino EMAIL matlsonlandconsult idoud.com fit MAILING ADDRESS 2122788th Ave CITY Graham STATE WA ZIP 98338 z PHONE 2es22o-79e2 CELL _..( PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number) 321275300213 ZANING RR5 LEGAL DESCRIPTION(Abbreviated) LAKE LIMERICK 4 TRACT 213 FIRE DISTRICT III, o 7 SITE ADDRESS 491 E Olds Lyme Rd CITY Shelton W DIRECTIONS TO SITE ADDRESS Sea attached driving directions IV, a IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO IR SNOW LOAD: IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Lack-cfasa opy): SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF[3 STREAM TYPE OF WORK: NEW]ff ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(R,vbyxe,Ga,,Commercia7B1 Bx.) residence IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS I HEATED STRUCTURE? YES(ww,,s g1)9 YES ffa fvcyBw)❑ NO❑ DESCRIBE WORK remove existing manufactured home and install a new manufactured home SOUARE FOOTAGE: /p,apa so 1ST FLOOR 710 sq.ft. 2ND FLOOR sq.ft. JED FLOOR sq.ft BASEMENT sq.ft DECIl sq.& COVERED DECK sq.ft STORAGE sq.R OTHER sq.& GARAGE sq.& Attached❑ Detached❑ CARPORT sq.& Attached❑ Detached❑ Q MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLOOR PLAN REQUIRED" MAKE Fleetwood MODEL Sandpointe YEAR 2023 LENGTH 52 WIDTH 14 BEDROOMS 2 BATHS 1 SERIAL NUMBER a ENVIRONMENTAL HEALTH: SEWAGPJSEWER SOURCE: SEPTIC SEWER / NEW18 EXISTING PLUMBING IN STRUCTURE? YES N NO❑ Ijys,attach completed Water Adequacy Form PERRAETERNOUNDATION DRAINS PROPOSED? YES❑ NOR EXISTING SQ.FT. EXISTINGBEDROOMS PROPOSED BEDROOMS 2 TOTALBEDROOMS�_ OWNER acknowleoges that submission of inaccumts 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 entil ed to receive this permit and to do the work as proposed.I have obtained permission from all the necessary partles,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 stnicture(s)for review and Inspection. This pannit/application becomes null&void a work or suthorized construction Is not commenced Mthin 180 days or a 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 COUNTY CODE 14.08.42) J 9/21/2023 X 8igrlarLreof OWNER(Must Ce aianed by the OWNER) Date — o 7im art wueve =' Rmyo s ..T Vti N _9 2Na t 4 z s° •4� 109t x4 8® _% O2T.WALK.4.8AY �9 6� s 4 (`q0 a ` !r;it \|| |% ( ( ®, \� !� §) H (u 0 l ;;) \o2 � E ° §3 ] ( ! 99\ /\' \� � / q\ cn \ \\ \ £ , % a , RE R-� � ! \ ^ �e . 2 REMO ©o . iw§ ® t : . Wip ! ^ , R§ § > _N�__ FROM_FIELD) y