HomeMy WebLinkAboutBLD2022-01118 - BLD CD Environmental Health Review - 8/23/2022 (2) ,,,...v'c'''''''. .1 MASON COUNTY COMMUNITY SERVICES Permit No:OZ.Oct 022,-0(l5
PERMIT ASSISTANCE CENTER: RECEIVED
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5 I I `F' •BUILDING•PLANNING15 •PUBLIC er SVeet Street, •A g1RE 8584 MARSHAL K E! _
j.f q Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone AUG
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'24 AN AU�IJJ v Bellair(360)275-4467•Phone Elma:(360)482-5269 2 3 1LLL ENVIRONMENTAL
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BUILDING PERMIT APPLICATntA W. Airier Street HEALTH
PROPERTY OWNER INFORMATION:/ CONTRACTOR INFORMATION:
NAME: pew,/S 7 4�' flsdh// ,,// NAME:
MAILING ADDJSS: 9/3 /d 1v a left e live MAILING ADDRESS:
CITY: Sr.�j /T ✓A, STATE:ry ZIP: -574,/ CITY: STATE: ZIP:
PHONE#1: 7m 2 — tea/ — �79"e> PHONE: CELL: _
PHONE#2: EMAIL•'
EMAIL: ls,,/S4r//?�/ s���jcl!/ �da'J 1 L&I REG# EXP._/_/
PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER❑
NAME EMAIL
MAILING ADDRESS CITY STATE ZIP
PHONE CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 3 c.rl RR,7 -c/- e i /7/ ZONING
LEGAL DESCRIPTION(Abbreviated) / FIRE DISTRILCT,
SITE ADDRESS Sot/ �. R0c24/ 67)-2.!CC ' CITY Sljr// ' kJ
DIRECTIONS TO SITE ADDRESS ili C/2,,rt pv .I B g0,/ �r ,.7 rlcc i/`_,,,'c r k k
7' .q v--{i-c4-,. PA./.— - - 1 c;7` .sue'-F- RP./ 4Dc- 7 i-2/cc
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NOFSNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER 0 LAKE❑ RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF STREAM❑
TYPE OF WORK: NEW/K ADDITION 0 ALTERATION 0 /REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage.Commercial Bldg,Etc.) ee•5 I ryC,u G e J�
IS USE: PRIMARY'K SEASONAL D NUMBER OF BEDROOMS ( NUMBER OF BATHROOMS ) C
1 HEATED STRUCTURE? YES(Whole Bldg)X YES(Part[s]of Bldg)❑ NO 0
DESCRIBE WORK au%/ ' spew ham«se
SOUARE FOOTAGE:(proposed) •
1ST FLOOR 960sq.ft. 2ND FLOOR l�y/9 sq.ft. 3RD FLOOR i//) sq.ft. BASEMENT N/.4 sq.ft.
COVERED DECK /Xi, sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE /635sq.ft. Attached 0 Detached CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: N/� *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL !! YEAR LENGTH
WIDTH _ BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH: Cp_- Slt- Y Lot 4- C(rq;l
SEWAGE/SEWER SOURCE: SEPTIC' SEWER 0 / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES NO❑ If ,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YESg NI.._, EXISTING SQ.FT.
EXISTING BEDROOMS O PROPOSED BEDROOMS f TOTAL BEDROOMS I
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 properly
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 it 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
PER -AP LICATION OF 18 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
i �COUNTY CODE 14.08.42)
Signature of OWNER st be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL n� 1
PUBLIC HEALTH ‘3Joi3 v U•PFC+�'
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