HomeMy WebLinkAboutBLD2023-00521 - BLD CD Environmental Health Review - 5/15/2023 • MASON COUNTY Permit No: eL94,20,23 -On53.1
COMMUNITY DEVELOPISHENIE IVED
Permit Assistance Center,Building,Planning
MAY 1 0 2023
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFroAyyokIder Street
NAME: (Sr.. /44.,,^0 NAME:(„Ni'„j, / ((-4 ire _
MAILING ADDRESS: 4.g5 MAILING ADI'iRESS: IJ (2,1.,, e:
CITY: 4 I I„ STATE: ZIP: ?.?"f CITY: (Lk-.4 STATE: ZIP: i•;.51,;.51 o
PHONE#1:' C LC.2- PHONE: jt( • c:Lly CELL:
PHONE#2: .E; /- i7l - EMAIL: )1-:. . Lt
EMAIL: . 1 ft.1 IS cr • L&I REG# EXP. / /
PRIMARY CONTACT: OWNER 0 CONTRACTOR g OTHER 0
NAME ? i I .7 EMAIL .c%11, i'; ,^1;.-> 4,it •
MAILING ADDRESS 6 q v,A C.'.: CITY e STATE .ZIP q'>1,4.1
PHONE 31.t.: fZ7 -,;:Ci CELL
ENVIRONtri ENTAL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 1) 3 G.0;IC ZONING HEALTH
LEGAL DESCRIPTION(Abbreviated) t" 6 I hi el iv/if 7,2- FIRE DISTRICT
SITE ADDRESS -7 IC 1; L-e•7e.ivr,, Lr.-. ka_ CITY -511z tiv 4
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESD NO p• SNOW LOAD: psi
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER El LAKE RIVER/CREEK D POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM
TYPE OF WORK: NEW RI ADDITION D ALTERATION 0 REPAIR D OTHER D
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Etc) rcyti /IS USE:USE: PRIMARY @ SEASONAL El NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)RI YES(Part[s]of Bldg)D NO 0
DESCRIBE WORK -Pt/
SQUARE FOOTAGE:6,roposed)
1ST FLOOR 2- sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR - sq.ft. BASEMENT - sq.II
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE - sq.ft. Attached El Detached E CARPORT - sq.ft. Attached 9 Detached
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE t (-tit (-I MODEL ri PC l• 2.91-4, YEAR 2-1:'LI 3 LENGTH 7 0 Y
WIDTH 1'; ••C" BEDROOMS 3 BATHS SERIAL NUMBER I5;1-3 eCii 15' 2
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 4 SEWER 0 / NEW 0 EXISTING
PLUMBING IN STRUCTURE? YES la NO D If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 NOE EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS TOTAL BEDROOMS
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 are the owner and I further declare that I are 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 ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
P)CLC)1 a• Crt_s ) - -
Stgriature ofOWNER(Must be signed by OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGSINOTESICONDMONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH (0 () Li
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