HomeMy WebLinkAboutBLD2023-00479 - BLD CD Environmental Health Review - 5/2/2023 Permit No:QLQ( 3.-5-co -7
MASON COUNTY !! y
'' - COMMUNITY DEVELOPMENT:,.,C 1\ ':7i--
;` Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION Y - �U4�
PROPERTY OWNER INFORMATION: CONTRACTOR'IIV O(ii11Q, `FIQNi )] R0 MENTAL
NAME:/4 Z/ ...1a �/00 NAME: NV IRO
MAILING ADDRESS:7/Y3 ="„I2221Ak((c O 02 MAILING ADDRESS: HE A LT H
CITY:Lift
PHONE#1'� 0 3/O STATE:}
' ZIP. `9 1�PHONE:CITY: STATE:
CELL: ZIP:
PHONE 42: 2. EMAIL:
EMAIL:__ __ u Mr3;a 1 a cfr.m M L&I REG# EXP. /_/
PRIMARY CONTACT: OWNER,t CONTRACTOR❑ QTHER 0 • 11 n�1
NAME AYa►� Cry ' JO..> EMAIL/4JO)�Iw)SO.7&NOl,.fM1�iA4Ik7N✓I • tv
MAILING ADDRESS 7/93 -Z d 7--(4)no,IVN 2.AO CITY (A k_e-i.2an STATE I.I4 ZIP I 0 y q ,r
PHONE .Z 5 3 3-74,— '7 167 CELL )c� _pp .2 x '
PARCEL INFORMATION: �� I
PARCEL NUMBER(12 Digit Number) 3 2-1 0 4/57O 22 ZONING 73 IN
LEGAL DESCRIPTION(A_bbreviated) L.0 r 4/2 0 t✓ E3 FIRE DISTRICT n o
SITE ADDRESS E G`A1S77")0t7.7 L..A1 CITY U.A3,0 m - 2
DIRECTIONS TO SITE ADDRESS m a
v
w
IS THE PROJECT WITHIN 300 FT OF SLOPE(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 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEWS' ADDITION❑ ALTERATION❑ REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,&c.) ✓1 G ✓'eito."0/1
IS USE: PRIMARY❑ SEASONAL, NUMBER OF BEDROOMS 5 NUMBER OF BATHROOMS a
HEATED STRUCTURE? YES(Whole Bldg)II YES(Part[s]of Bldg)❑ NO 0
DESCRIBE WORK
SQUARE FOOTAGE: (proposed) l y/♦ A
1ST FLOOR 17 0 q.ft. 2ND FLOOR a1 k sq.ft. 3RD FLOOR [1/ 11 sq.ft. BASEMENT df/t sq.ft.
DECK sq.ft. COVERED DECK 19 0 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE 6.3? sq.ft. Attached h Detached❑ CARPORT sq.ft. Attached 0 Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC a SEWER 0 / NEW,' EXISTING❑
PLUMBING IN STRUCTURE? YES XI NO 0 \\ ,,Ifyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDRO MS 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.
PROOF OF CONTINUATION OF WORK THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 A F MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X (_ 6= 2_ - 2223
Signature of OWNE Mu be signed by the OWNER) Date
DEPARTMENTAL REVIE APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL _`
PUBLIC HEALTH I 5�7j5 (cfNC1-( X1
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