HomeMy WebLinkAboutBLD2024-00280 - BLD CD Environmental Health Review - 3/8/2024 Permit No: [JLIld47;,laT�19
MASON COUNTY EN� TIIf� 1L
COMMUNITY DEVELOPMENT HPFL4'1924
Permit Assistance Center,Bullding,Planning
BUILDING PERMIT APPLICATION 615 W. Alder
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: -14
NAME:
RICK PHILLIPS NAME:T.B.D.
MAILING ADDRESS:4111 NE 92nd STREET MAILING ADDRESS: d
CITy:VANCOUVER STATE:WA Zlp:98668 CITY: STATE: ZIP: O O
PHONE#1:36D807-0719 PHONE: CELL:
PHONE#2: E LaJL:
EMAIL:dckp4942�gmail.com L&I REG# ERP.—I
PRIMARY CONTACT: OWNER❑+ CONTRACTOR❑ OTHER❑
NAME EMAIL
MAILING ADDRESS CITY STATE_ ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 4213550MG25 ZONINGRR 2.5
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS490 W CLEAR LAKE DRIVE CrrYSHELTON
DIRECTIONS TO SITE ADDRESS NORTH ON HWY 101,LEFT ON W CLEAR LAKE DRIVE,PROPERTY IS ON THE RIGHT 112 MILE
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER TRAN 14%: YES[] NOD SNOW LOAD:25—Psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Chectandal apply):
SALTWATER❑ LARE❑+ RIVERtCREEK❑ POND ❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW g' ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Randmc4 Garage,Co ,vislBldg•Bx.)RESIDENCE
IS USE: PRIMARY❑+ SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS2
HEATED STRUCTURE? YES(IVAole tdds)❑ YES(Porr(,],fB1ds) v NO❑
DESCRIBE WORK LWSV�
SOUA_RE FOOTAGE:.(prepared/
IST FLOOR2523 sq.fL 2ND FLOOR �""gy�pp sq.ft. 3RD FLOOR sq.ft. 1BASEMENT sq.
DECK sq.fL COVERED DECKJ&L sq.8. STORAGE sq.ft. OTHEIL sq.ft.
GARAGE663 sq.ft. Attached❑+ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
E INFORMATION: "4 COPIES OF THE FLOOR PLAN REQUIRED"
MA
MAKE MODEL LENC'TI
WIDTH BEDROOMS BATHS SERIAI.NUMBER
ENVIRONMENTAL HEALTH:
SEWAGFISEWER SOURCE: SEPTIC❑+ SEWER❑ ( NEW❑ EMSTING 0
PLUMBING IN STRUCTURE? YES ❑v NO❑ Ijyes, attach completed Water Adequacy Form
PERIMETERWOUNDATION DRAINS PROPOSED? YES❑ NOR] EXISTING SQ.FT.
EXISTING BEDROOMS I PROPOSED BEDROOMS 3 TOTAL BEDROOMS
OWNER acknowledges that submission of Inaccurate informatlon 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 entltied to receive this permit and W do the work as proposed.I have
obtained permission from all We necessary parties,including any easement holder or padres of Interest regarding this project The owner or legal
representative,represents that the information provided Is accurate and grants employees of Mason County access W me above desai bed property
and sbucfure(s)for review and Inspection. This pemlibapplirat on becomes null 8 void If work or authorized construction is not commenced wMan 180
days or If construction work Is suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT 15 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)
02-15-24
Signature of OWNER(Must bsigned b the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSINOTESICONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL )
PUBLIC HEALTH I I
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