HomeMy WebLinkAboutBLD2024-01268 - BLD CD Environmental Health Review - 10/29/2024 MASON COUNTY POrmitNo:B=024wass -olatd6
COMMUNITY DEVELOPMENrfrrECEIVfIoED
Permit Assistance Center, Building,Planning IYVJI wrl gRTAL
BUILDING PERMIT APPLICATION 61firw eat
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:MMRMARK ESTATE MMl4GEMEIR SERVICES,UC NAME:FNRMNK CANSiRUCTpN COMPPNY
MAILING ADDRESS:td"O NE FOIma DR.SURE as MAR.INGADDRESS:aosuolseNnvE_- up
CITY: KIRKIAND STATE: WA ZIP: 98033 CITY: MINBRIDGEISIAND STATE: WA ZIP: 981
PHONE#1: 425.57e.3393 PHONE: 2c 02-24s9 CELL: M4514679 O
PHONE#2:425-753-7`755 EMAIL :—KGFM suMI NmMucmo —
EMAIL: dm ell-Owernmad-ll000m L&I REG#FUReccleocs ExP, 06/25/
PRIMARY CONTACT: OWNER[I CONTRACTOR❑ OTHER[]'
NAME DERRICK MINIKEN,ONNERREPRESEMAINE EMAIL denickm@watermark-Ilacom
MAILINGADDRESS 15129NE92MSl CITY ludwind STATE WA ZIP 98052
PHONE 4 D5 FM CELL 4257537755
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 322335000901 ZONING RRS
LEGAL DESCRIPTION(Abbreviated) SUNNY BEACH M 5A a TAX 977-B FIRE DISTRICT 6
SITE ADDRESS 6999E STATE ROUTE 106 CITY UNION
DIRECTIONS TO SITE ADDRESS Travel East from Union on Highway,106,PmWty on left lost before Aldmitrook Resort
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 144/R: YES[] NO E SNOW LOAD:25 Sf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check alithat,tK):
SALTWATER 0 LAKE❑ RIVER/CRE K❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW❑ ADDITION[]+ ALTERATION []' REPAIR❑ OTHER []+
USE OF STRUCTURE(Bsalde.,,Gmag,Commercial Bldg,Ere) RESIDENCE
IS USE: PRIMARY ❑ SEASONAL Ej NUMBER OF BEDROOM NUMBER OF BATHROOMS 4
HEATED STRUCTURE? YES I'Whok Bldg) 0 YES(Part(a)ofBIdg)❑ NO❑ (3 FULL, 2 HALF)
DESCRIBE WORK REFURBISHMENT OF EKISTING SINGLES ORY RESIDENCE,INCLUDING KITCHEN REMODEL&BATHROOM ADDITIONS.
SOUARE FOOTAGE: (prepared)
I ST FLOOR 5149 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE r64 sq.ft. Aaached Q Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC[]' SEWER❑ / NEW❑ EXISTING 0
PLUMBING IN STRUCTURE? YES El NO ❑ Ijyes, attach completed Water Adequacy Form
PERIMETERTOUNDATION DRAMS PROPOSED? YES El 3
,.yNO[] EXISTING SQ.FT. U471
EXISTING BEDROOMS 2 PROPOSED BEDROOMSj�.✓ TOTAL BEDROOMS !i'
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such Is by
signature below. I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,including any easement holder or parties of Interest regarding this project The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s)for review,and inspection. This permNapplicart on becomes null It void s work or authorized construction is not commenced within 180
days or if construction work he suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
P`�`�`�---///�����{{yrr��tlT APPLjjj���ATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
j J ' COUNTY CODE 14.08.42) (of
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Signature of OWNER(Must be sinned by the OWNER) Dale
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE I TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL ' I
PUBLIC HEALTH
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