HomeMy WebLinkAboutBLD2024-00460 - BLD CD Environmental Health Review - 4/12/2024 I a
Permit No:�J�Ct Z�2-`-F' ��LeO
,,. �.- , MASON COUNTYRECEIVED
COMMUNITY DEVELOPMENT
MAR 1 II MA
•v i r't'' Permit Assistance Center, Building,Planning 1 O1
615 fil. Alder V(i c t
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:JERRY AND CYNTHIA RADTKE NAME:
MAILING ADDRESS:Po s0X1473 MAILING ADDRESS:
CITY:SHELTON STATE:WA ZIP:96584 CITY: STATE: ZIP:
PHONE#1:36°49°2869 PHONE: CELL:
PHONE#2:36°49°7943 EMAIL :
EMAIL:CYNTHIA.RADTKE@GMIAL.COM L&I REG# EXP. / /
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER❑ lo
NAME IAINMORRIS EMAIL MIN®WILLIAMS-ARCHITECTURE.COM 4.)
MAILING ADDRESS 601 W RAILROAD AVE P.O.BOX 102 CITY SHELTON STATE WA ZIP
PHONE 060»26-0511 CELL NA 'A,_ `'
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 420014190043 ZONING SHELTON UGA
LEGAL DESCRIPTION(Abbreviated) LOT 3 OF sP113137 AF42198930 S 31/7,S 41/72 S 45/135 S53/124-125 FIRE DISTRICT 5
SITE ADDRESS 105°E ISLAND LAKE DR LOT 3 CITY SHELTON
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES NO 0 SNOW LOAD: • psf
1S PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER ❑ LAKE 0 RIVER/CREEK❑ POND 0 WETLAND ❑ SEASONAL RUNOFF❑ STREAM ❑
TYPE OF WORK: NEW 0 ADDITION ❑ ALTERATION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence, Garage.Commercial Bldg.Etc.)RESIDENCE
IS USE: PRIMARY 0 SEASONAL El NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS 3.5
HEATED STRUCTURE? YES(Whole Bldg) ❑ YES (Part[s]of Bldg) 0 NO 0
DESCRIBE WORK NEW RESIDENCE WITH ATTACHED GARAGE
SQUARE FOOTAGE: (proposed)
1ST FLOOR 1350 sq. ft. 2ND FLOOR 1210 sq. ft. 3RD FLOOR NA sq. ft. BASEMENT NA sq. ft.
DECK NA sq. ft. COVERED DECK 26° sq. ft. STORAGE sq.ft. OTHER sq. ft.
GARAGE 675 sq. ft. Attached 0 Detached❑Z(L�.,,,t,Grj`��P�6RT sq. ft. Attache Detached❑
MANUFACTURED HOME INFORMATION: `*4 COPIES OF THE FLOOR PLAN REQUIRED*
MAK � ODEL YEA LENGTH
TH BEDROOMS SERIAL NUMBER - ._ ,
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWER 0 / NEW 0 EXISTING❑
PLUMBING IN STRUCTURE? YES B NO ❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NOO EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS_ _ TOTAL BEDROOMS .
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
t 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 PPN9ATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
COUNTY CODE 14.08.42)
x I Z/1/2eL3
gnature of OWNER (Must be sipped by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH • 9- q/Z115 r3,uc 2n2 _ i 5
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