HomeMy WebLinkAboutBLD2024-00236 - BLD CD Environmental Health Review - 2/26/2024 MASON COUNTY Permit Ni I/)kA - 062- o
COMMUNITY DEVELOPMEKJCEIVED
Permit Assistance Center, Building,Planning B 26 2024
BUILDING PERMIT APPLICATION 615 W.Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: z
NAME:Ronald and Sue Marshall NAME:F s L Pinsk 3G LLC
MAEANG ADDRESS:21 SE Kit=Ridge Ln MAILING ADDRESS:2510 Sandra Ave,SN e
CITY:Shelton STATE:W'A ZIP:9' 4 CITY:Centralia STATRWA 23P;00331 O
PHONE#1: PHONE:3607384286 CELL: z
PHONE#2: EMAIL:
EMAIL: L&I REG#FLPACP3W3M7 EXP,_ Q2 z
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER Q+ n
NAME E°'a'°'""'""'0fa an°c°'°A'atkr.er""""" EMAIL evenJreanpamlittgmall.com
MAILING ADDRESS 1873 S.Market Blvd.•132 CITY Civ ew STATE WA 21
PHONE x ouh CELL
PARCEL INFORMATION: FFe?BZD
PARCEL NUMBER(12 Digit Number) 32035-7500051 ZONING 2
LEGALDESCRO'TION(Abbreviated) wrlarepw+apnrra ewarlrmoarrm,awo FIRE?DISTRICT F/
SITE ADDRESS21 SE Whits Ridge Ln Cr ry I hatton
DIRECTIONS TO SITE ADDRESS amameaa.mad,mnoasecw pewee ywa sd,roes nosy.se msawaa.Ndkr tn.emwi man wr.
IS THE PROTECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESD NO E] SNOW LOAD:2?�af
IS PROPERTY WITHIN 200 FP OF THE FOLLOWING: (CheckaB star aypty):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW ADDITION❑ ALTERATION❑ REPAIR OTHER Q
USE OF STRUCTURE(Berdwn c Gd ,Commerool Bdy Em.)Realderlm wlih atlarl�etl garage
IS USE: PRIMARY 0+ SEASONAL❑ NUMBER OF BEDROOM32 NUMBER OF BATHROOMS2
HEATED STRUCTURE? YES()YbokBW[3 YES(Pw*H]a]B4y❑ NO❑
DESCRIBE WORKNew 2 Bedroom SFR
S T FLOO FOOTAGE: (p ND t1C �EME I -'
(✓l
1ST FLOOR1251 sq.R 2ND FLOOR sq.R 3RD FLOOR eq.R BASEMENT seq.R
DECK sq.R COVERED DECK121 sq.R. STORAGE, sq.R. OTHER+ sq.ft.
GARAGE I S Ia, sq.R Attached E+ Detached❑ CARPORT sq.& Attached❑ Detached❑
MANUFACTURED HO '4 COPIES OF THE FLOOR PLAN REQUIRED'
MAKE MODEL LENGTH
BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER❑ / NEW❑ EXISTING E]
PLUMBING IN STRUCTURE? YES 0 NO❑ lfyws,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOG+ EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 2 TOTAL BEDROOMS 2
OWNER acknowledges that submission of Inaccunb Information may result In a stW work antler or pemlR rewedon.AtlaloWedgemerd of such Is by
signature below.I declare that I am the owner and I further declare Nat I am entitled to lemma this permit and to do the work as proposed.I have
obtained permission from all the namssary panes,Including any easement holder or Writes of Interest regarding this protect The owner or lariat
repmeantative.represents that the information provided is accurate end grants employees of Mason County access to the shave described property
anti atmaure(s)wr ravel and Inspection. This pelmlVappllmtion beoamas null&void If work or auamdzed construction Is not commenced within IN
days or IF mnsbuctlon work Is suspended for a pared of 180 days.
PROOF OF CO F WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLIC f N 00 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X
SEnatu of O NER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED I DATEF DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH 3 I
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