HomeMy WebLinkAboutBLD2024-00966 - BLD CD Environmental Health Review - 8/12/2024 MASON COUNTY Permit No: 0LNo T— (dp
COMMUNITY DEVELOPMENTRECEIVED
Permit Assistance Center, Building,Planning qSTA; -
PHONEft(m)"S-55�16 EA�1PAL
BUILDING PERMIT APPLICATIOSteet
PROPERTY OWNER INFORMATION: CONTRACTOR IN46
NAME:fthsly LevanselIer NAME:Future Home ServkG 11
MAILING ADDRESS:101 E C"h l6ne MAILING ADDRESS: (r
CITY:RwNr STATE:con ZIP:sell CITY:Tag Hsbx au
(m)"S-5ese PHONE:3soaoo-see2PHONE#2: EMAIL:EMAIL: L&I REG#F11rUMSn431l7/25
PRIMARY CONTACT: OWNER I] CONTRACTOR 0 OTHER 0+
NAME J t4a ssst EMAIL jessn®rMamsomest«mu.mm
MAILING ADDRESS sas 10Rh 8TR CITY Temme STATE WA ZIP 9e444
PHONE ^+'s^re axr2++ CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 122211500100 ZONING RRs
LEGAL DESCRIPTION(Abbreviated) a+vmkOFmIOOFSURVEYWIM,C,wREEDORoesMCOeem4ism FIRBDISTRICTs
SITE ADDRESS ld1 E Corbin are CITY sews
DIRECTIONS TO SITE ADDRESS WA 3 N abaghtto E NO Ray Rd.Cominue mw WA 3U E,:iEW E y RD.
RaMo E Cerbn Ln.Oeetiretlon an kh
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NOB SNOW LOAD:2L—pd
IS PROPERTY WITH IN 200 FT OF THE FOLLOWING: (Clreckaliao,q,,i,):
SALTWATER❑ LAKE❑ RIVER/CREE,K❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW Qi ADDITION ALTERATION REPAIR❑ OTHER Q+ Arm
USE OF STRUCTURE(Rerldeace.Gamin,conseemdewp,Er.J Rmlde,re sou
IS USE: PRIMARY Q+ SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(wkde R)dg) 0+ YES(varr[e]oy'Rtds)❑ NO❑
DESCRIBE WORK Install Bedroom.Can 2 Bath ADU
SQUARE FOOTAGE: (Pr yord)
IST FLOOR IAA sq.R 2ND FLOOR sq.R 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK 12 sq.ft. COVERED DECK sq.ft STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Atached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE FI66Maod MODELEagb YEAR2025 LENGTHss
WH)TH2r BEDROOMS2 BATHS2 SERIAL NUMBER Ind yet Will
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0' SEWER❑ / NEW a EXISTING❑
PLUMBING IN STRUCTURE? YES Q+ NO❑ Ijyes, attach completed WaterAdequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOO+ EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS 2 TOTAL BEDROOMS 2
OWNER acimmaledges that submbslon of Inaccurate information may result in a stop work order or perms revocauen.Acknoaledgemenl of such Is by
signature below.I declare that I am the carer and I further dedare that I am entitled to receive this permit and to do the work as proposed.I have
obtained parr iDn f.all the necessary ladles,Including any easement holder or parties of Interest regarding this project. The owner or legal
representative,represents Nat the Information provided is accurate and shams employees of Mason County access to the above described Poperty
antl stmcture(s)for review and Inspection. This pennlyapplication becomes null 6 void Rwodr or authorized construction is not commenced Within 180
days or if construction work is suspended for a pedod 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
'^,�'� ^/,^- COUNTY CODE 14.08.42)
X w"wy (Yl/Cl4fE(d,R/ 08-05-2024
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH L4ILy Ir�t.s
Document Ref.7ZMQ,0J8EMEM3HI-0FOZU
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