HomeMy WebLinkAboutBLD2020-00488 - BLD Plot / Site Plans - 6/27/2022 ' a ,
� o1rZ 0�UI i i i � ‘ � _ ( ® ol _ aE ;I.
MASON COUNTY .. - _. -. ._ _ ..
COMMUNITY SERVICES
oo �p+J ��� . 40 Id I�q 5 l ®C eel wz, eD•
Permit Numb BL COM:Z02(� �,
` Applicant Name Email: u tM
Phone#: Project Title: 1' Parcel Number:1 2.a0 50-WZO 8
Please provide a complete, detailed description of the proposed revisions to the approved plans. Please
return thjs form to the Mason C unty Permit Center.
rri o v c Id ci 2020- -rf'o rY)(I)Cu)GHQ. I i,2,?1) -•56-4[oo03
cn ! a2saa-.SD-- 8 I o I I✓ Naar) . new t in.a.e.T --e.r'
1.._5.ew.m...a,,n c(, WC. *4-' 24L2 ucte-y C y L VELD LSLtL ei c
The following documents are required toile submitted with this form. -i
> One set of revised plans or addendum indicating the changes. Yes_ No_
> One set of the approved construction plans. Y _ No_
(The"Red Stamped" approved site plan must be included)
➢ Revisions are to be clouded with delta's clearly and accurately identifi ----
on the revised plan/s or addendum. Yes_ No_
> Does the plan contain a structural, architectural or soils .en neer analysis? Yes_ No_
(If yes, has the Registered Professional/s approve.thig revision) Yes_ No_
(Is a stamped and signed approval included this request) Yes_ No_
(If no engineering or other changes re. ng a registered professional have been
made, the plan may be approve. ' out written consent of the engineer or
architect of record)
➢ Does the propose. ision modify the footprint or location of the structure/s? Yes_ No_
(If YES, is a revi •site plan,with all new setback dimensions included with this request?)
Yes No
Additions formation:
Applicants Signature: Date:
STAFF REVIEW SECTION
Reviewed by: _,'i t_Q.i
Department Date Assigned Date Reviewers
for Review Received Reviewer Approved Approval Origin I V luation: $
Additional Valuation: $
Building , O
V Sq.Ft. X $
Sq.Ft. X $
Planning 6W 1-1-
Additional Fees: $
'Ij Additional Plan Review: $
Public (/L�/A �W / Additional Building Permit: $
Health 2o22- lit Additional Plumbing: $
Additional Mechanical: $
Fire Other: $
Marshal \''
Total Due: $
-ter
Public -
Works
Page 1 of 1