HomeMy WebLinkAboutBLD2024-01080 - BLD CD Environmental Health Review - 9/5/2024 MASON COUNTY Permit No: 61-0202.4- 010$0
COMMUNITY DEVELOPMENT
Permit Assistance Center, Building,Planning REe � ? ,.
BUILDING PERMIT APPLICATION SEP 0 5 2024 ���
PROPERTY OWNER INFORMATION: CONTRACTORINFORNA H)11L•_
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NAME: �!1 r r l + IOyG�,S q�f7't_��i NAME:Masan County Fx ttng
MAILING ADDRESS: X/P Ala rfrE Kee d Itf0S MAILING ADDRESS:30 EwRlcher Blvd
CITY: SAa/-)s» STATE:]0'—ZIP:48sf Shan Y CITY: STATE:`NA zrp:g85B4
PHONE#1: 9ICq. 9yat dl 7 PHONE:360 426 0674 CELL: 3604903144—,5--"
PHONE#2: S EMAIL;mesoncamxyvetiagOyahoo,can --
EMAIL: of 3 . a .— L&I REG#MASONCE915PM EXp. /
PRIMARY CONTACT: OWNER EJ CONTRACTOR❑ OTHER❑
NAME rr EMAIL
MAILINGADDRESS E eaf #4fOS CITY S /11+n STATE N A 71p6 PT
PHONE CELL 9l9-9VY—f47" ---
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 2202475-90043 ZONING
LEGAL DESCRIPTION(Abbreviated) TR 4 OF SURVEY 21123 LOT:3 OF SP$2815 FIRE DISTRICT
SITE ADDRESS 140 E Elm Ln CITY Shelton
DMECITONS TO SITE ADDRESS From Harsone Island Bridge sum rWA on E Island Rd S,at nsfop sign turn right on E Hmslkre Island Rd S.
1.5 miles from stop sign turn right on E FJm Ln.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO E SNOW LOAD:psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: fa xdt mwo�tyj:
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW E] ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Resdmc4 On,,,,Cosseere/ai Bldg,Erc)Fssidencs
IS USE: PRIMARY EJ SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES Ophel i;W❑ YES(Perpj] fBfitd❑ NO❑
DESCRIBE WORKNew Manufactured Home
SOUARE FOOTAGE: (pmpw.ect
1ST FLOOR 18a8 sq.ft. 2ND FLOOR sq.R 3RD FLOOR sq.R BASEMENT sq.ft
DECK400 sq.R COVERED DECK sq.ft. STORAGE sq.ft OTHERaq.ft.
GARAGE sq.1L Attached❑ Detached❑ CARPORT sq.ft- Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED- r
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MAKE Evergreen MODEL 28603E YEAR 2024 LENGTN60 Ft ~
NN=26 Ft 8 Inches BEDROOMS 3 BATHS 2 SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGEtSEWER SOURCE: SEPTIC B SEWER❑ 7 NEW B EXISTING❑
PLUMBING IN STRUCTURE? YES[] NO❑ Ifyed,attach eomp/eled WaterAdequacyForm
PERIMET ERNOUNDATION DRAINS PROPOSED? YES E1 NO[] EXISTING SQ,FT.
EXISTING BEDROOMS PROPOSED BEDROOMS _ TOTAL BEDROOMS
OWNER adodwtedges that submission of inaccurate information may resuit In a slop work order or Permit revooatlon.Acknowledgement of such is by
signahms below.I decors that I am the owner and I fuller declare that 1 am waffled to receive this pamrit and to do the wont as eoposod.I have
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. the owner or legal
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Maeon county does not require surveys for
CIObuilding As a result,site plans may not reflect 315 Ff
I_ L.L aaunits dale.It is the applicant's responsibility
to rwmply with se0ack requirements.
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