HomeMy WebLinkAboutBLD2025-00405 - BLD CD Environmental Health Review - 4/3/2025 MASON COUNTY
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COMMUNITY DEVELOPMENT APR — 1 2025
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Permit Assistance Center,Building,Planning perR
BUILDING PERMIT APPLICATIOr�15 W. tiNv otyqm ENTAL
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: HEALTH
NAME:' s',K Edcaon NAME:Doyle Construction I Daniel Doyle
MAILING ADDRESS:270 N Beach Dr MAILING ADDRESS:300 Deschutes Way SW.Suite 215 v
CITY:Pad Lido" STATE:WA ZIP:9e385 CITY:Tt"iM1°°r STATE:WA ZIP:sssol
PHONE#1:360-930.1748 PHONE:380A1"158 CELL: 36°491 38„ 5
PHONE#2: EMAIL:OeNsleOo .com
EMAIL: L&I REG#DO`LEoL815L7 EXP. 07/13/25 " �
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER 0 ) o ' 3
NAME 1'4'4DO° EMAIL Daniel@Doytesusds°°m (i C ,
MAILING ADDRESS 300D°schuteswaSW,Suite215 CITY TUr»�g STATE WA ZIP�501 m tC
PHONE 3e09's4156 CELL 07913611 C, s,
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 42332-51.00008 ZONING T23NRSW
LEGAL DESCRIPTION(Abbreviated) Lake Cushman#13 TR 8,S 49/23 FIRE DISTRICT District 18
SITE ADDRESS 5793 N Lake Cutlrnan Rd CITY Hoodspat 98548
DIRECTIONS TO SITE ADDRESS Tram West off US101 onto WA119(N Lake Cushman Rd)and travel 5.5 min and property will be
on the west side of the Roadway.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO 0 SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION❑ REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence Garage,Commercial Bldg,Etc)Resider"
IS USE: PRIMARY 0 SEASONAL 0 NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Pan(s]of Bldg)0 NO❑
DESCRIBE WORK New Rea1ded"Carsbit red
SOUARE FOOTAGE:(proposed)
1ST FLOOR488 sq.ft. 2ND FLOOR992 sq.ft. 3RD FLOOR N A sq.ft. BASEMENT NA sq.ft.
DECK 24° sq.ft. COVERED DECK NA sq.ft. STORAGE NA sq.ft. OTHER NA sq.R
GARAGE 503 sq.ft. Attached 0 Detached 0 CARPORT NA sq.ft. Attached 0 Detached 0
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MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE NA MODEL NA YEAR NA LENGTH NA
WIDTH NA BEDROOMS NA BATHS NA SERIAL NUMBER NA
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ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC El SEWER❑ / NEW O EXISTING
PLUMBING IN STRUCTURE? YES El NO 0 ljyes.attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOD EXISTING SQ.FT.°
EXISTING BEDROOMS ° PROPOSED BEDROOMS 2 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 access to the above described property
and structure(s)for review and inspection. This permit/application becomes null&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
P RMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42) 1 / 3 O/�01
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re of 0 ER(Must be signed bY the OWNER) Date
• DE A!a NTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
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