HomeMy WebLinkAboutBLD2025-00273 - BLD CD Environmental Health Review - 3/11/2025 �' Permit1
� MASON COUNTYdr8',--,7
'' �' COMMUNITY DEVELOPMENT MAR 10 2025
...,wrr�-- Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:D AND STEPHANIE DEGROFF NAME:TBD
MAILING ADDRESS:1344 FERN ST SW MAILING ADDRESS:
CITY:OLYMPIA STATE:WA ZIP:98502 - CITY: STATE: ZIP:
PHONE#1:36W-359'2°17 PHONE: CELL: <IN I
PHONE#2: EMAIL: 0
EMAIL:STEPHANIEMV2009@COMCAST.NET L&I REG# EXP._/_/_ L
PRIMARY CONTACT: OWNER 0 CONTRACTOR❑ OTHER❑ 0IC)
NAME 0DEGROFF EMAIL
MAILING ADDRESS 1344 FERN ST SW CITY OLYMPIA STATE WA zip 98502
PHONE CELL 360359.2017
PARCEL INFORMATION: 32.-12.- - , ,00, - d°11 O
PARCEL NUMBER(I2 Digit Number)a 0O ZONING RESIDENTIAL 5 ACRES
LEGAL DESCRIPTION(Abbreviated) TR11 OF Govr LOT 1 FIRE DISTRICT•e 1 -/—
SITE ADDRESS 38060 N HWY 101 CITY LILLYWAUP
DIRECTIONS TO SITE ADDRESS NORTH ON HWY 101,END AT 38060 N HWY 101
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO 0 SNOW LOAD:25 psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND❑ WETLAND D SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Etc.)RESIDENCE
IS USE: PRIMARY j SEASONAL 0 NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Part[s]of Bldg)❑ NO 0
DESCRIBE WORK ADDITION OF A BATHROOM AND UTILITY ROOM
SOUARE FOOTAGE: (proposed)
' 1ST FLOOR33O 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 sq.ft. Attached❑ Detached 0 CARPORT sq.ft. Attached❑ Detached 0
MATACTURED HOME INFORMATION: *4 COPIE N REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BATHS SERIAL NUMBER ,
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC r❑ SEWER 0 / NEW 0 EXISTING 0
PLUMBING IN STRUCTURE? YES 0 NO❑ If yes.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOD EXISTING SQ.FT.
EXISTING BEDROOMS 2 PROPOSED BEDROOMS 0 TOTAL BEDROOMS 2
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 arras to the above described property
and structure(s)for review and inspection. This pernit/application becomes null 8 void if work or authorized construction is not commenced within 180
days or if 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
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
OUNTY CODE 14.08.42)
X /0 sign 3- /0- ZS
Signature of OWNER(Must be by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH a S(i��ii MdJ/ PPI f ate./
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