HomeMy WebLinkAboutBLD2024-00961 - BLD CD Environmental Health Review - 8/11/2024 Permit No: C !�
MASON COUNTY RE EIV D.
COMMUNITY DEVELOPMENT AUG os M§
Permit Assistance Center,Building,Planning
615 W. Alder Street
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: M
NAME:Dan&Sere Hem NAME:Hem Land It Homes
MAILING ADDRESS:1M23 DdeMemy St StyMAILING ADDRES5:18023 FddeMary St sw
CITY:Rocheemr Si ZIP:98619 CITY:Rochester STATE;WA ZIP:
PHONE#1:36o-Tg0-a001 PHONE:3M-T�07 CELL:
PHONE#2: EMAIL:dan.dmhoonstrudtion®gmNl.com
EMAH.:dan4mhoomaudion®gmell.oam L&I REG# EXP.
PRIMARY CONTACT: OWNER0 CONTRAC I) ❑ OTHER[] z
NAME amseese^ EMAIL
MAILING ADDRESS CITY STATE_
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 31804-1143003D ZONING
LEGAL DESCRIPTION(Ablamiated) razes ausaazrsm'eea°rm°F az raeatrst FIRE DISTRICT
SITE ADDRESS 200 SE Sister Meadow Ln CITYShelton
DIRECTIONS TO SITE ADDRESS Hwy 3S,left an SE Creg Rd.I.R..SE Cola Rd,oft on on SE Slater Meadow U
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESD NO Q SNOW LOAD:25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check I Neraepty):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW E] ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Romesa Garage,CommedafBldg,ea f Residenoa
IS USE: PIUMARYID SEASONAL❑ NUMBER OF BEDR00MS4 NUMBER OF BATHROOMS3
HEATED STRUCTURE? YES(addlB/dgi YES(Port(,)oi`Bfdr)❑ NO❑
DESCRIBE WORKNew 4 Bediown SFR
SOUARE FOOTAGE: t vosi
IST FLOOR3N3 sq.ft. 2ND FLOOR Iq.R 3RD FLOOR sq.fL BASEMENT sq.O
DECK sq.fL COVERED DECK tsq.ft. STORAGH sq.ft. OTHER sq.&
GARAGE1042 sq.1L Attached Q Detached❑ CARPORT sq.R Attached❑ Detached
MANUFACTURED HOME INFORMATION: w4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH - BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC E+ SEWER❑ / NEW 2] EXISTING❑
PLUMBING IN STRUCTURE? YES El NO❑ Ijyea,attach completed Water Adequacy Form
PER]METER&OUNDATION DRAINS PROPOSED? YES❑ NO[] EXISTING SQ.Fr.
EXISTING BEDROOMS PROPOSED BEDROOMS 4 TOTAL BEDROOMS
OWNER acanovhedgee Nat suhmleelun of Inaccurate information may result In a atop work order or permit revocation.Addhowl udgemerd of ouch Is by
sghature below.I declare that I am the owner and I further dedam that I am entitled to mi Mi.pari and to do the work as proposed.I have
obtained permission from.11 to necessary partim.including any easement holder or pars,of interest regarding this poled. The awnm or legal
representative.reprmenb that she information provided to accurate and grents empbyem of Mason County access M the above described property
and structures)for review and inspection. This pemiiVapplication becomm null It void if"i or eulhorimd mnsbuction is not commenced within 180
days or d construction work is suspended for a Period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
P R APPLICATION OF 1110 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
Signature of OWNER(Must be signed b the OWNER) Date
DEPARTMENTAL REVIEW APPROVED I DATE I DENIED I DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL r�
PUBLIC REAL
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