HomeMy WebLinkAboutBLD2022-00575 - BLD CD Environmental Health Review - 6/24/2022 Wr
BUILDING PERMIT APPLICATION • ,' -.' 28) - ♦45 j
PROPERTY OWNER,I,NFORM TION: CONTRACTOR INFORMATION:
NAME 't76 4- JJ,I1L( I / NAME: RECEIVED
MAIL �G DRESS: : I ( MAILING ADDRESS:
CITY: ' S tA,TE_ ZIP: CITY: STA n I4 2
PHONE#1: " 1 f / C PHONE: C n L '
PHONE#2: ;. D ., (. ek er 1 /110 EMAIL :
EMAIL; /, d , I REG# 615 W. q�( Str�etl .
PRIMARY CONTACT: OWNER❑ CONTRACTOR❑ OTHER
NAME I-,Gt.W(1, Z.- Ci/M EMAIL Z 1.1/10ti i Ic.lev" VC{ilk:().LO/14 =
MAILING ADDRESS })C, t3Cn. SI(e CITY 6,Y,:4PCVIC'Li) STATE W:t ZIP`f1f %41' -I. 1"—
PHONE (t;D - 3.—P.,-"( ) . CELL Q
PARCEL INFORMATION: ID W
PARCEL NUMBER(12 Digit Number) 2 i oci -. .)I -OJJ J ZONING _
LEGAL DESCRIPTION(Abbreviated)`7 bt J '�rc , , 7'1(I�) FIRE DISTRICTr
r(7
SITE ADDRESS '1 E5 I /V r- kkd` Li '71 i.?ie c d CITY }--?I&1 Ir ],01.( , cft e:..-5
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO' ,
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER LAKE ❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF ❑ STREAM❑
TYPE OF WORK: NEW ❑ ADDITION R ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg Etc) f�W (g
IS USE: PRIMARY❑ SEASONAL ❑ NUMBER OF BEDRIdOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(WholeBldg) [ YES(Part[s)of Bldg) ❑ NO❑ IF
DESCRIBE WORK !J LLL` c k ..4 4 A et 1''C(G -) V A if•' -
IL
SQUARE FOOTAGE: (propose+existing)
1ST FLOOR `tea!0 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 I /0 sq.ft. Attached a Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH l.J
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW ❑ EXISTING ,
PLUMBING IN STRUCTURE? YES ❑ NO . Ifyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES'$ NO EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 0- TOTAL BEDROOMS � j -.
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 WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPL AA jION O 1 0 DAYS OF MORE WILLCAUSETHEAPPLICATION TO BE EXPIRED.(MASON
COUNODE1408.42)X 5 ij _z
S n NER s bythe OWNER)
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
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