HomeMy WebLinkAboutBLD2021-01509 - BLD CD Environmental Health Review - 12/12/2022 1r PROPERTY OWNER INFORMATION: CON!KA R INFORMATION:CTO /
— PERTJ
v NAME: Rek I�cocr -tl' I1 L LC NAME: I�Q ea✓ -I-A-GU 1
MAILING ADDRESS: f"1O6-47(e-L I, S-1" ' Lil-/.5 MAILING ADDRESS: (-70 Ft 1' `In
.yN
CITY: LL A) STATE:L4 IP: 1k7 Y CITY: Lyia 6.-40/J STATE: ZIP:g 8 7-6,V
PHONE i I: 3 4,0 9Z'7 ./S-1 PH 3W 715760 CELL: 17-b0 ._
PHONE g2: 3100 '1!�- D !o 6 tt E �W y/r, i� ul t
EMAl7-: 'JO(}k)AINSTIZA0/Ala% t'Go/vi L&I REGIt Rp,pix-yaDS�.iru.t EXP. '7 //L/ 2.
PRIMARY CONTACT: OWNER ["CONTRACTOR OTHER❑ I.
NAME -Z'a i}l1/4) w y 111 S I d(b EMAIL G(>�/V ST1214a144 1'/ I Z-6'44
MAILING ADDRESS b'! CITY STATE (,L> ZIP 9d"71v
# i-
PHONE g60 a -7 I -7 ELL 3 0 0 -71 6,0
PARCEL INFORMATION: • y At-H y ,�
PARCEL NUMBER(12 Digit Number) / Z-?-7 - 5>� -G,3O)! ZONING Ay , /Z- '-2—
I,tgFL/4��J YI\ d.h�f /( �-3 6- f)1 FIRE CITY DISTRICT
SITE ADDRESS! 14- le Y
DIRECT/I.'I�ONS� �TOpSITE ADDRESS t or! 3�u✓AJ km) r
eit,„'
IS THEPROJECTWIT IT
N 300 FT OF SLO 'E(S)GREATER THAN 14%: YES❑ NO SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW/ADDITION ❑ ALTERATION❑ REPAIR❑ OTHER O.
USE OF STRUCTURE (Residence,Garage,Commercial Bldg.Etc.)12NC41
USE: PRIMARY �,YJ/ SEASONAL ❑ NUMBER OF BEDROOMS_, ' NUMBE. J RC�L} ,S D._
IS
HEATED STRUCTURE? YES(Whole Bldg) YES (Part(s)of Bldg) n NO ❑ 4 DEC 12 .2022
DESCRIBE WORK z40ju5752 I D tU O4-- UGC) /e.-e. AlC-to G1 W.-Alder Street
SQUARE FOOTAGE: Goroposed) OH ill 615 W: Alder Street
1ST FLOOR3S c sq. ft. 2ND FLOOR ) O e sq.ft. 3RD FLOOR sq.ft. BASEMENT s
0'.
DECK sq.ft. COVERED DECK E (f 0 sq. ft. STORAGE sq.ft. OTHER .- ft.Z J
GARAGE 1 X.7 sq. ft. Attached❑ Detached❑ CARPORT sq. ft. Attached❑ Detached n L1,1 I
-
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REOCl.
M.AKL' MODEL YEAR LENGTH_ = C
N
WIDTH BEDROOMS BATHS SERIAL UMBER s . . .
ENVIRONMENTAL HEALTH: 41/
SEWAGE/SEWER SOURCE: SEPTIC ❑ SEWER V / NEW FJ EXISTING ❑
PLUMBING jN STRUCTURES YES NO ❑ Ifyes, attach completed Water Adequacy Form
,V O e - mil - EXISTING SQ.FT:.
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NO❑
. EXISTING BEDROOMS PROPOSED BEDROOMS 3 TOTAL BEDROOMS 3
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.
ON.
VITY
F
PROOF OF CONTINUATION OF DAYS OF MOORK ON IS RE WILL! CAUSET IS BY ITHE APPLICATION TEANS OF IO BEIEXP EXPIRED.(M SON
PE MIT APPLICATION OF 180� COUNTY CODE 14.08.42)
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iIIj . e. 0Mu5tb0 signed by the OWNER)
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