HomeMy WebLinkAboutBLD2024-00385 - BLD CD Environmental Health Review - 3/21/2024 ENVIRONkiENTAL Permit Nw�I,Qab V=
MASON COUNTY HEALTH. ^�EIVE�v3g�
COMMUNITY DEVELOPMENT
Permit Assistance Center, Building,Planning MAR 21 2024
BUILDING PERMIT APPLICAaPQIIV. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: v
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NAME:Roderic Dahlman and Ryan Finn ]NAME;HiUne Homae �mn
MAILING ADDRESS:ID3 W Story Rd MAILING ADDRESS:PO Box 799 2. 1
CITN:Shelton STAICE:W'A ZIP: CITY:Elmo STATE:WA ZIN O v
PHONE hi:310-210-1867 PHONE:360-4B2-4227x2311 CELL:
PHONE N2:416-310-2648 EMAIL:EMotlroDnlakChllinehomes.corn
ENTAIL:bothofuslitrdoomputer.com L&I REG#HILINH•983BD
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑
NAME Rr.s Ra EMAIL boftfus@rdcomputer.com
MAILING ADDRESS 103 W Story Rd CITY S1 W STATE WA ZIPS5"
PHONE 61541oae10 CELL 4164104 P13
PARCEL INFORMATION: - I
PARCEL NUMBER(12 Digit Number) 32131-14-MIO ZONINORRS
LEGAL DESCRIPTION(Abbreviated) Res.PCL 1 BLA 21-18,PTN BE NE 31-20-3 FIRE DISTRICI4
SITE ADDRESS 107 W Story Rd CITYShelton
DIRECTIONS TO SITE ADDRESS From SR3 approaching US 101 from Shelton: Go antler the overpass and SR 3 becomes Goltlen
Pheasant Take first RIGHT onto W.Story. Take BM ddVeway an LEFT. Subject property IS on the RIGHT(follow Signs to'107').
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NOB SNOW LOAD:25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Chakd(dratoypty):
SALTWATER❑ LAKE❑ IRIVER/CREEK❑ POND❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW 0 ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Raid.,Garogr,Coaaaacul R74g,Rta)ReNtlerwe
IS USE: PRIMARY 13 SEASONAL❑ NUMBER OF BEDROOMS 1 NUMBER OF BATHROOMS 1
HEATED STRUCTURE? YES(Wh kBkW p YES(PanNI oJRldg)❑ NO❑
DESCRIBE WORK500 sq ILADU(ADU Is being built first mein residence an this property to follow In 2028).
SQUARE FOOTAGE: (praposd)
1ST FLOOR600 sq.ft 2ND FLOOR sq.ft. 3RD FLOOR sq.ft BASEMENT sq.ft.
DECK sq.ft COVERED DECK sq.& STORAGE sq.ft. OTHER sq.It, -
GARAGE sq.ft Attached❑ Detached❑ CARPORT sq.R Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: •4 COPIES OF THE FLOOR PLAN REQUIRED"
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENvHtONMENTA ,HEALTH:
SEWAGEISEWER SOURCE:- SEPTICD SEWER❑ / NEW EXISTING
PLUMBING IN STRUCTURE? YES ❑' NO❑ Ijyes,attach completed WaterAdegaacy Form
PERIMETERNOUNDATION DRAINS PROPOSED? YES Q NO[] EXISTING SQ.FT.0
EXISTING BEDROOMS 0 " PROPOSED BEDROOMS 1 TOTAL BEDROOMS-I
OWNER acknowledges that submission of Inaccurate informalion may result in a slop work order or permit revocetlon.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
oblalned�glset n from all the necessary parties.Including any easement holder or parties of Interest regarding this project The owner or legal
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PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTrV YOF THIS
PERMIT MPUCATION OF 180 DAYS OF MORE DUND'M CAUSE
DE THE APPLICATION TO BE EXPIRED.(MASON
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