HomeMy WebLinkAboutBLD2024-00765 - BLD CD Environmental Health Review - 7/2/2024 MASON COUNTY Permit No:&W(1Gi,�"�}OP5
COMMUNITY DEVELOPME �Ep
Permit Assistance Center, Building,Planning
BUILDING PERMIT APPLICATION 1UN 25 kil
PROPERTY OWNER INFORMATION: CONTRACTOR INF9R5NFI� ONAME:Rober Brson NAME:Home OwrrarMAILING ADDRESS:819 S uaecson Ave MAILING ADDRESS:CITY:Tamn;aSTATE:WA ZIP:wm CITY: ST�A,aT,Ef :PHONE#1:sog ies PHONE: plyPHONE#2: EMAIL:
EMAIL:bbryson1951®gmea.ram L&IREG#
PRIMARY CONTACT: OWNER 0+ CONTRACTOR❑ OTHER❑
NAME adwnayren EMAIL blbyem19510wnall.¢m
MAILING ADDRESS 819 B Jackson Ave CITY Tam+ STATE WA ZIP 911
PHONE 300a ees CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 2201752,00038 ZONING RRs
LEGAL DESCRIPTION(Abbreviated) TIMBER E010 S W134 TR 38 FIRE DISTRICTS
SITE ADDR,SS M E Budd Dr CITY Shelton
DIRECTIONS TO SITE ADDRESS From Agate Rd.TL on E Timberlake Or,TR E lake Dr W,TR E Timber Pkwy,TL E LakasMre Dr E,
TR E Budd M Nlowin site on right,
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO w SNOW LOAD:25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Checkdtdmtup*):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM
TYPE OF WORK: NEWrR�`ADDIION ❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(xr.;d z,Garoge,Cmmre tvoIB&k
IS USE: PRIMARY E+ SEASONAL[I NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(while BkW 0 YES(Parris)ufBldq) ❑ NO
DESCRIBE WORK lnetall new manufactured Home
SQUARE FOOTAGE: (prop d)
1ST FLOOR 1512 sq.R. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK 176 sq.ft. COVERED DECK sq.ft. STORAGE sq.R OTHER sq.ft.
GARAGE sq.R Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE Goldenwest MODEL Cream yEAR2025 LENGTHN
WIDTH 27 BEDROOMS 3 BATHS 2 SERIAL NUMBER TSD
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER❑ / NEW❑ EXISTING 0
PLUMBING IN STRUCTURE? YES[+ NO❑ Ijyes, attach completed Water Adequacy Farm
PERAIETERNOUNDATION DRAINS PROPOSED? YES ❑ NOD ]OUSTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
OWNER adtnowledges that submission of inaccurate Intonation may result In a stop work order or permit revocation.Acknowledgement of such is by
signature below.I declare Met I and Me owner and I fuller declare that I and entitled to receive this permit and to do the work as proposed.I have
obtained permission frond all Me necessary parties,Including any easement holder or parties of Interest regarding this project. The owner or legal
representative,represent that the information provided is accurate and grants employees of Mason County access to the above described property
all structure(s)for review add inspection. This permi lapplialion becomes null 8 void if work or authorized construction its not commenced wiNin 18D
days or N construction work is suspended for a period of IN 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
COUNTY CODE 14.08.42)
X 91 � lb a
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDTTIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH ( ��
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