HomeMy WebLinkAboutbld2024-00633 - BLD CD Environmental Health Review - 5/24/2024 MASON COUNTY Permit No:
COMMUNITY DEVELOP WITED
NMpBrIrYI31 istance Center, Building,Planning
HEALTH�1 �I//�t� BUILDING PERMIT APPLICATION MAY 2 1 2024 A y
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: 2 a—
NAME:David Jones NAME:MS dirhworke r
MAILING ADDRESS:13203 68TH AVE CT E MAILING ADDRESS:
CITY:PuyBmp STATE:WA ZIP:96323 CITY: STATE: ZIP:
PHONE#I: PHONE:253-861-8426 CELL:
PHONE#2: EMAIL:MBDimam*s;@gmail.wm
ESL:sound0ooringlnstaladon®gmsl.com L&I REG#MBDIRD'801KR -EXP. 06/0b/24
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER❑+
NAME Jasw Campbell(applkartl EMAIL )aeon@fuatrehomesbwma.com
MAILING ADDRESS 11211133rd STE CITY Puyallup STATE WA Zip 98374
PHONE 283.2413 94 CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 323095110001 ZONING fws
LEGAL DESCRIPTION(Abbreviated) COLONY SURF 2 BLK:10 LOT:1 FIRE DISTRICT 11
SITE ADDRESS 210 N LAKE SURF DR CITY Uliwaup
DIRECTIONS TO SITE ADDRESS Haadbg North w 101 Turn Laterite Kam Plain,turn left en N CobW Sud d,Turn lea on NwHol Drtu stay w
N Colony Sud G. ColoW Suff IX becomes N Lake Surf Dr,site on on Ne met side of the mad.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO❑ SNOW LOAD: 2_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Cherkat that Wpbq:
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND ❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW p ADDITION ❑ ALTERATION ❑ REPAIR❑ OTHER PI
USE OF STRUCTURE(Eastdena,caragr Cornmemml Bldg,Etc.)residence
IS USE: PRIMARY ❑+ SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES male Bldg) Q YES(Pan(s]ofBldg)❑ NO❑
DESCRIBE WORK melel new manufactured!home.Existing home already removed.
SOUARE FOOTAGE: Itmaywo 0
1ST FLOOR 1066 sq.ft. 2ND FLOOR sq.R 3RD FLOOR sq.ft BASEMENT sq.ft.
DECK U sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.It.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLOOR PLAN REQUIRED"
MAKE Fleetwood MODEL Pura Hanes YEAR 2024 LENGTH 44
WIDTH 24 BEDROOMS 3 BATHS 2 SERIAL NUMBER Not yet built
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC❑i SEWER❑ / NEW EI EXISTING 0
PLUMBING IN STRUCTURE? YES❑+ NO❑ IJ'yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ VAO❑i EXISTING SQ.FT
EXISTING BEDROOMS 0 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 necasmry parties,including any easement holder or pathos of interest regarning me 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 stmcture(s)for review and inspection. This permftapplmadw becomes null&void twark or authorized construction is not commenced within 180
days or if construction work is suspended far 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
Signature:
COUNTY CODE 14.08.42)
15/OS/24
X o,. +wha,et<mmenrnl
Signa R Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSINOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL �1
PUBLIC HEALTH / 3I m Lv�
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