HomeMy WebLinkAboutBLD2025-00379 - BLD CD Environmental Health Review - 4/2/2025 5157 R{. : MASON COUNTY Permit No:t/ l .fiJ!` !. /7' L_ '
COMMUNITY DEVELOPMENT
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A 2 7 2025
M
-.;� ;;,-. Permit Assistance Center,Building,Planning
615 W, Alder S r
BUILDING PERMIT APPLICATION ENV Ar reel
TAL
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:PANDORA HOPE NAME:
HILINE HOMES HEALTH
MAILING ADDRESS:4455 NW SHELLEY DR MAILING ADDRESS:11875 Silverdale Way NW Ste 105
CITY:SILVERDALE STATE:WA ZIP:98383 CITY:Silverdale STATE:WA ZIP:98383
PHONE#1:380-536-5098 PHONE:25394°1849 CELL: 3609990432
PHONE#2: EMAIL:emodrobinak@hilinehomes.com A^ v
CIV
EMAIL:PANDORA 6@MSN.COM Led REG#HILINH'769J3 EXP.04/23/ APR 0
PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER 0 R -025
NAME PANDORA HOPE EMAIL PANDORA_BHMSN.COM FCky
MAILING ADDRESS 4455 NW SHELLEY DR CITY SILVERDALE STATE WA ZIP 98383 v�0
PHONE 3eoe365o98 CELL 36as36-5o9e
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 32127-53-00207 ZONING RESIDENTIAL
LEGAL DESCRIPTION(Abbreviated) 422 E.OLDE LYME RD FIRE DISTRICT MASON
SITE ADDRESS 422 E.OLDE LYME RD CITY SHELTON
DIRECTIONS TO SITE ADDRESS FROM SHELTON,TAKE HWY 3,TURN LEFT ONTO E MASON LAKE RD,TURN RIGHT ONTO
E.OLDE LYME RD.
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❑ LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0 ADDITION 0 ALTERATION❑ REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage.Commercial Bldg,Etc.)RESIDENCE
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 1
HEATED STRUCTURE? YES(Whole Bldg)0 YES(Part(s)of Bldg)❑ NO 0
DESCRIBE WORK CONSTRUCTION OF NEW 843 SQFT HOME
SQUARE FOOTAGE:(proposed)
1ST FLOOR 843 sq.ft. 2ND FLOOR N/A sq.ft. 3RD FLOOR N/A _sq.ft. BASEMENT N/A sq.ft.
DECK N/A sq.ft. COVERED DECK N/A sq.ft. STORAGE N/A sq.ft. OTHER N/A sq.ft.
GARAGE" sq.ft. Attached 0 Detached 0 CARPORT N/A sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE NIA MODEL N/A YEAR N/A LENGTH N/A
WIDTH N/A BEDROOMS N/A BATHS N/A SERIAL NUMBER N/A
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC .❑ SEWER 0 / NEW 9 EXISTING 0
PLUMBING IN STRUCTURE? YES +❑ NO 0 Ifyes,attach com feted Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES N 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 1 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
repre ve,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and s ctu s)for review and inspection. This permit/application becomes null&void if work or authorized construction is not commenced within 180
daysor if co truction wo is suspended for a period of 180 days.
PROOF F CONT.NUATION OF K ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
;PER APPLI ATION OF 1 0 D YS OF MORE WILL CAUSE THE APPLICAT N TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42) Z. 13>I W7
X a/tAl,
Signature of OWNER(Mus at ed by the OWNER) Date
I DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL C� J�
PUBLIC HEALTH I(F� I PII K '1 ' JC Cdied
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