HomeMy WebLinkAboutBLD2023-01525 - BLD CD Environmental Health Review - 12/22/2023 ® BUILDING PERMIT APPLICATION '�Id 202� Ol�ati
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Calm Russell NAME:Coval hones \"1✓ M
MAILING ADDRESS:310 Kmaln That Lam MAILING ADDRESS:1—Pottery Ave
CITY:Tayuhe STATE:WA ZIP;eesea CITY:Pon aenam STATE:WA ZIP:88896
PHONE#1: O PHONE:a6O-6w-lM CELL:
PHONE#2: EMAIL ;In1-Ill—ilnmm.eom
EMAIL:collin.ree.mssellOgmml.cgn L&I REG#COVALH1-88401) EXT.
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER El
NAME crydnl kfermn EMAIL mmuonlenticanutt®kbud.com rn
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MAILINGADDRESS 3133T88MAve E CITY Onnem STATE WA ZIP 3B33e
PHONE 25a22e-746e CELL 25403 a 7615s D
PARCEL INFORMATION: r
PARCEL NUMBER(12 Digit Number) 32384-24-0 M ZONING Rural Resident E O�
LEGAL DESCRIPTION(Abbreviated) SW BE NW FIRE DISTRICT fC 1
SITE ADDRESS,3M lK1sNhq Tree Lam Jh 12 CITY Tayuha
DIRECTIONS TO SITE ADDRESS follow WA-300 W,NE Beltair Tahuya Rd and Dewam Bay Road turn letterer Dairy Queen,turn
1a ady on WA-sm W,o�ntinue amo NE NorIM1 Store Rtl.Nm dgM mM NE Bettalr Tahuya Roeq Wm rgMam Dswatto Bey Rd,wm rgmamo geain True m
IS THE PROTECT WITHIN 300 FT OF SLOPES)GREATER THAN 14%: YES[] NO 0 SNOW LOAD: 25 ys
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checkae"wly):
SALTWATER❑ LAKEO RIVER/CREEK❑ POND❑ WETLAND❑ SEASONALRUNOFF0 STREAM
TYPE OF WORK: NEW Q ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER I]
USE OF STRUCTURE(Ruidmce.Oaeoge,Commercial Bidg,Etc)Residence
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 1
HEATED STRUCTURE? YES(RSata Bldg) 0 YES(Part(]o/BIW❑ NO❑
DESCRIBE WORK To construct a 1000 square foot home
SOUARE FOOTAGE: (prapmedJ _
1ST FLOOR 1.000 sq.R. 2ND FLOOR O sq.ft. 3RD FLOORO sq.ft. BASEMENT O sq.ft.
DECKO sq.ft. COVERED DECKIoe sq.ft. STORAOEO sq.ft. OTHERO sq.ft.
GARAGE O sq.ft. Attached❑ Detached❑ CARPORTO sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: •4 COPIES OF THE FLOOR PLAN REQUIRED- �7
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGEISEWER SOURCE: SEPTIC 0+ SEWER❑ / NEW I] EXISTING❑
PLUMBING IN STRUCTURE? YES 0 NO O Ifyes,attach rom Iefed W, ferAdequacy Form
PERIMETERNOUNDATION DRAINS PROPOSED? YES El N EXISTING SQ.FT. 3,875 /
EXISTING BEDROOMS D PROPOSED BEDROOMS 2 VVV TOTAL BEDROOMS A�
OWNER acknowledges that submission of Inaccurate information may result in a stop work order or peork revocation.Acknowledgement of such is by
signature below.I declare that I am the owner and!I further declare that I am eM'Ned to reneiva this ennit and to do the work es proposed.I have
obtained permission from all the necessary parties,including any easement holder or pedies of interest regarding this project The owner en legal
representative,represents that the thermal provided is accurate and theme employees of Masco County access to the above described property
and stuture(s)for review and inspection. This permivapplication becomes null&void wok or auMorced construction is not commenced vdthin 180
days or if construction work is suspended for a period a 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
Caoemamdto COUNTY CODE 14.08.42)
X
94AWfi 6/29/2023
' �igna�ureO OWNER(Must be stared by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED I DATE DENIED I DATE I TAGS/NOTESfCONDITIONS
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