HomeMy WebLinkAboutBLD2024-00964 - BLD CD Environmental Health Review - 8/12/2024 MASON COUNTY Permit No:?)y- 0a,j - 66tiIA4
COMMUNITY DEVELOPMENTECEIVED
Permit Assistance Center, Building,Planning %UG 08 2024
BUILDING PERMIT APPLICATION �L_5,V der Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:Jason Bennett NAME:Future Home Services M
MAILING ADDRESS:2800 Sagemill Dr MAILING ADDRESS:PO BOX 2503
CITY:Muaewo STATE:CA ZIP:gaab9 CITY:Gig Harbor STATE:m ZIP:saris
PHONE#1:61661�1121 PHONE:xo-saasm2 CELL:
PHONE#2: EMAIL: M O
EMAH,:berawtussongroperhammall.mm L&I REG#FMRHST/BDo EXP. 03/17/2 Z
PRIMARY CONTACT: OWNER D CONTRACTOR D OTHER�+ = rn
NAME �asncanFbal EMAIL Iasm®wwreheme:moasamm Z
MAILING ADDRESS 406 lbsh SA CITY T— SPATE M ZIPeb+44
PHONE 251*41�EXT211 CELL )Y
r
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) M1103S111m10 ZONINGRM q
LEGAL DESCRIPTION(Abbreviated) NlMS1n N1n SWWOFRIW FIRE DISTRICT
SITE ADDRESS 781 E W.Berea Rd CITY Orepeslew C
DIRECTIONS TO SITE ADDRESS Fmm wn 3N Tum Ism onro Mason Benson Rd E,tmvv m wean loll (S
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESD NO❑ SNOW LOAD:J13f
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: paskanthreapply/:
SALTWATER❑ LAKE❑ RWER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM D
TYPE OF WORK: NEW❑ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER a home replacement
USE OF STRUCTURE(Eesidiawe,Garage.Cmranercml Bldg,Ex.1 resNence -
IS USE: PRIMARY De SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(nok Bldg)0 YES(Pentiv f BtogJ❑ NO❑
DESCRIBE WORK new 2Tx48 2 Badman♦Den 2 Bat Manufactured Home
SQUARE FOOTAGE: (prop wadi
1ST FLOOR 12e9 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.R
DECK a2 sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached D Detoched❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUR2ED*
MAKE Fkabvood MODEL Eagle YEAR2M LENGTH*B
WIDTH 27 BEDROOMS2 BATHS2 SERiALNUMBERNmyaeuin
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER D / NEW D EXISTING D+
PLUMBINGIN STRUCTURE? YESD+ NOD Ijyes, atfach completed troger Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES NOD+ EXISTING SQ.FT.
EXISTING BEDROOMS 2In W Was PROPOSED BEDROOMS 2 TOTAL BEDROOMS 2
OWNER aGnovAedges that submission of inaccurate information may result In a stop vnrk order or permit maocabon.A sanovbeagemem of such is by
signature below,)declare that I am the owner and I further declare that I am entitled to receive this pemdi and to do the and,as proposed.I have
obtained permission fiom ell the necessary parties,including any easement holder or parties of interest regarding this preject. The owner or legal
re Tadao tNe,represents that the infmmabon provided is accurate and grams employees of Mason County access to the above described property
end structure(s)for review and inspection. This permiVapplicagon becomes null&vold If work or authorized construction is not commenced within 180
days or 8conshuctian work is susperided for a period 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 14.08A2)
1�R X m Safte 08-06-2024
Signature of OWNER(Must be signed by the OWNER? Date
DEPARTMENTAL REVIEW APPROVED DATE I DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH 41 ("') r„ t-tat I
Document Ref MU3FA-UW6OZ-0U29J-SOSTU
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