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Home My WebLink AboutBLD2024-00799 - BLD CD Environmental Health Review - 7/2/2024 o�smr EmrmPe to:sewAaFS-gFas4saraE6o-6nedu6zDaa On O � !�_ MASON COUNTY COMMUNITY SERVICES Permit No: O` I PERMRASS/STANCE CENTER: �� . � .BIIII gNG.PIANNING•PUBfIL HEALTH•ERE MAFS4AL 615 W.Nr's SOeN,SMXm.WAS&SM = Fna.Spam:(Emu>.gma..a5z.iex:Pm„iT.P)pgFYme JUL 0 2 2024 — BeHaV(3�)3I5Jeal•PM1om Fps:(3e0N6R-5M9 BUILDING PERMIT APPLICATION , Alder SYcet PROPERTY OWNER INFORMATION: MNT_R_4i'TOR EdFORMATTON: A C NAME:EXEMPLARY FLOORING LLC m r NAME: ❑FNNIS PAVLOV Cf MAD,E4GADORESB:e "TE:AWA MAE-INUSURN SS:2sSTATEITN ANE m CITY:FEDERAL WWV STATE: WA 27P:80001 CIY:AUBURN STATE:WA Z�:e3601 m PHONE#1: PHONE: • 1 CELL: p PHONE#2: EMAE.:exemplMYAoalilpllc®DmaO.cDM EMAII.:Favlmeer^i6�yaM1m.cmn LS:I AEG#E){EMPFLBMNH EXP.OS 1141=4 PRIHARY CONTACT: OWNER❑ COHImui 0 BYRD& NANE '^• `..e EMAIL xWSM1^reQC D MAWNO ADDRESS PO BOX ggv CITY BELFAIR STATE WA _mp-map r PHONE 380-E01-/i32 CELL PARCEL INFORMATION: PARCELNfIMBERO2IBB1 NembR) 4221552-OOIQ ZONING L.EGALDESCRIPTION(Abb,savrtd) LAKE CUSHMAN#12 TR 143 S 54Na FIRE DISTRICT 18 STTEADDRESS 61 NTYEEPL CITY HOOOSPORT DIRECTIONS TO SITE ADDRESS Wei onW AMm SC ruN°too Oyrrpic Hwy N,bftwM W WMllew BNa,neryporlb US101 N, corn on WA-113"Isis CiAnmen Rd,Nftion WMt1a NM Lehe CUEM1rnan Rd,le11011b CuaM1menPotleltliRdLaA'eT Calm R4,bll IS THE PR W{TL RI'OF SLOPE(E)GAEATER TRAN I4%: YESD NOB SMW I04d1 IS PROPERTY WITHW 2M FT OP TBE FOISDW WG: !Gw mlNxrgPyJ: SALTWATER❑ LAKE❑ RNER/CREE PONCE] SEASONAL RUNOFF❑ STREAM K❑ TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER CT Di c ftw the fad USB OF STRUCTURE(aenamcc cmma cos eswmd4 EA.) u--mdda ISUSE: PRBURY❑ SEASONAL❑ NUMBER OF BEDROOMS_NUMBER OF BATHROOMS_ HEATED STRUCUBtET YES(whowat4[I❑ YE4(Aer41 yah91❑ NO❑ DESCRIBE WORK BDO A ft un6own4 t RIHIARE FOOTAGE:b'�amr•*alma) ISTFLOOR_eq.& 2NDFLOOR K & 3RDFI.00R_sl ft. BASEMENT_sl pECKG00 aq.R COVERED DECK nq.R STORAGE sRR OTHER_.i GARAGE sq.R AORcheA❑ Demhed❑ CARPORT l-ft. A#aLW❑ Dooso ❑ MAIyUFpCTURED HOME INFORMATION: -4 COPIES OF THE FLOOR PLAN REQUIRED' MAKE MODEL YEAR LENGTH WIDTH BEDROOMS BATHS SERIALNIIMEER ENVIRONMENTAL HEALTH: ' SEWAGE'SEWER SOURCE: SEPTICq SEWER❑ 1 NEW❑ EXISTWG� PLUM03ING W STAUCiLRtET YHR❑ NOW IJyvs,.h rvs A,e wmo Adequxy Fmm PERmfE11ERR/F'OUNDATION DRAWS PROPOSED' YES NOB EXISTING SQ PT. METING BEDROOMS PROPOSEDBIDROOMS TOTALHIDROOMS� OWNIffs Mee6maMSWn'uMm dFecwrele MlmmeYrn^Qs'r®uXMe MvesvVsnR reuoraB[w.Marsw.laUp+neMalwdrMM symlue MWv_IEe,m tF61 mn Ne si m INMer eesi NMI em-di W nsi Ws pvmtleM N Oa 1M'aariiasmgme].I o,so, pemiis•,.YI Ne nii,Dies.indWin9 eirye9emneirt ss.—{eN%Iii,n N renmtling Nls pi TM.vlega tii,ins We,repas sNe11M hma-pmodee Is acw2te and grants employees NMasm County as—b Ne..doi IYCFmb' my proctors(:)bre'.ia'x aN IrsgSnn.mia pertnvapdipt'ron�wmas minfleoiemwwka aalloriaed mnswossn is micvnmervxi x in I ame o nmruwcnm wen ia.oawmee to a passe m tm save. 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 10.Gli 6/28/20M X pep aS,ionum OVMER fM W I M M1 OWNERI DEPARTMENTALREVWW APPROVED DATE DENIED DATE TAGSMOTE&CONDTTIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FILE MARSHAL PUBLICHEALTH DowSign Envelope ID:9930MF19E35-6303-9E(113 27e454821D34 COMMUNITY DEVELOPMENT ENVIRONMENTAL HEALTH REVIEW Mason County Public Health Official use only 415 N. 6th Street Permit Number: PO Box 1666 Shelton, WA 98584 Date Received: Shelton: (360)427-9670, Ext. 400 Amount Received Belfair: (360)275-4467 Ext.400 Elma: (360)482-5269 Ext.400 Receipt Number Fax (360)427-7787 Applicant Information Type of Review Applicant DENNIS PAVLOV Date6/2812024 Ild Bui ing Permit Mailing Address 3303642ND AVE S V1 New ❑ Replacement FEDERAL WAY WA 98001 ❑ Commercial Building Permit city State Zip 0 New - Replacement 253-737-8667 360-801-4432 ❑ Building/Commercial Permit Revision Daytime Phone Other Phone ❑ Tenant Review E-Mail Address pavlovdennls@yahoo.com ❑ Pre-Application Parcel Information 12-Digit Parcel Number 42216-52-00143 Site Address 61 NE TYEE PL HOODSPORT WA 98548 Street Number Street Name City Type of Job Please submit a scaled plot plan 600 SO FT DECK-AFTER THE FACT showing all existing and proposed Describe work w/WAIVER building, on-site sewage system, Number of Bedrooms 0 and well. On-Site Sewage Information Water System Information Id On-Site Septic System ❑ New ¢Existing Plumbing in structure? ❑ Yes 1(No ❑ Sewer Name of Sewer System If yes: Using an existing on-site septic system will require a current Please submit a completed Water maintenance report and a Record Drawing (Asbuilt). Documents Adequacy Form. for both of these requirements may be on file with Mason County Public Health. Other requirements may apply. Applicant Signature "-� �j/ Date 6/28/2024 � �mecncazxwcz_. Official use only Departmental Review Approved Denied Notes Water Adequacy On-site Sewage System Tenant Review Revision Revised r917109 rR-= r �&a «Ae| > 0zz f0 § § § \\ § ) / % > ~% � E • &a < K i a ( \ kj � { ! ` ! � CD ! ! / ! \ 22 d } t ! ! r{ : co \ \» ! m ) k ¥ k -0 0 _ , 0 , MHrd o § o - - \ � -a - . . k § : & . ..