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HomeMy WebLinkAboutBLD2023-00710 - BLD CD Environmental Health Review - 5/8/2023 Permit NI k 6,8 007 I ,., MASON COUNTY R E C E COMMUNITY DEVELOPMENT Permit Assistance Center,Building,Planning MAY -8 2023 BUILDING PERMIT APPLICATIONAlder Street PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: ENVIRONMENTAL NAME-T;W1g E. F-FIrLI NAME: HE A LTH km 4$(i+ MAILING ADDRESS:1.1, 4 15"1'hIVE, ILL MAILING ADDRESS: _ CITY:SEA7TLE STATE:%N A ZIP:R$/O5 CITY: STATE: ZIP: PHONE#1: 21j4,A411. 331 9, PHONE: CELL: PHONE#2: � EMAIL: EMAIL:`T N E ADYEt1TVea elogrt,^�L•/I'4 L&I REG# EXP._/ /_ PRIMARY CONTACT: OWNER IQ CONTRACTOR 0 OTHER❑ IT) NAMETtmopfy (57OFFe.I ZQ. EMAIL C) r-) E i MAILING ADDRESS N33J/4'117 AVE NE,APT silt CITY SEP#LE STATE WA ZIPq$iOr C w PHONE CELL zoce, till, 33 J$ rn o PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number)524 O(0 }5 • 90 13 2 ZONING R R S" LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICTAV SON L011JN73 r' (� SITE ADDRESS/2/ &e VIEW OR., (ARON Wig CITY UNION DIRECTIONS TO SITE ADD'RESS 1/iv/ON 2/D6PE RD. —�' 5Ky VJEyJ b — 7Dp DFTLJ. /.( Fr;L IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO El'SNOW LOAD:21 psf IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): SALTWATER❑ LAKE❑ RIVERJCREEK 0 POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM 0 TYPE OF WORK: NEW©' ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑ USE OF STRUCTURE(Resrdeace,Garage.Commercial Bldg,Etc.) &/9efl /C 3/lJ IS USE: PRIMARY❑ SEASONAL EV NUMBER OF BEDROOMS / NUMBER OF BATHROOMS / HEATED STRUCTURE? YES(Whole Bldg)0 YES(Perils]of Bldg) NO❑ DESCRIBE WORK,JC/E l I/. N$T2VGTJON ON L -L 6720UNb-5L1113 SOUARE FOOTAGE:_ d)(propose 1ST FLOOR 15 .ft. 2ND FLOOR oI0b sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft. DECK /' sq.ft. COVERED DECK — sq.ft. STORAGE .— sq.ft. OTHER sq.ft. GARAGE ygg sq.ft. Attached 0 Detached 0 CARPORT ti sq.IL Attached❑ Detached❑ MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* MAKE MODEL LENGTH WIDTH BATHS SERIAL NUMBER ENVIRONMENTAL HEALTH: SEWAGE/SEWER SOURCE: SEPTIC(" SEWER❑ / NEW V EXISTING 0 PLUMBING IN STRUCTURE? YES I: NO 0 If yes,attach completed Water Adequacy Form PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO8-- EXISTING SQ.FT. EXISTING BEDROOMS PROPOSED BEDROOMS / 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 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) X WPM' wry ,0A5/1.. 2.3 26Z3 Signature of OW t b use signed by the OWNER) Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT FIRE MARSHAL PUBLIC HEALTH YsC f�(z3 G 4-ht4S I e,it• � h `- , , t 41m-u • 1I I •qZ i.\\ , ',i ,1 I • t , l I 1 i I I \., \ \ \ 'V I ` I k, i V V i- 1 !' ', �k--\- , 1 I 1 1f, ti1 t , gay 1 5 % 1 ; '\ 1 1 I ' t ` ' ' t ' , 1 ) j -=� t', /� � -.�11' \ \ .-r\'F�,j1 1�( ." ..0/ 1i y�''i / mill R.Vm Z�N I \ .i_ i N O 0,N 2.g odd3N�'� m \ I m �, I I s p=N rn 3 Hno,o rF i as a'alCi) • gd F ; !\ d Q $83 U) • 'qi$ 'o o .674 1 a a2 0ii.n0a.wu.nas l-IdV89Od01 s "H — — r I--- 1 i I I O i • m li � _ O 1 :. 3 7 O O cr,' < � m N o P ® ON W N IlliiIlillli l;li c) • f o I I ' ll I I IIIII R g I' !1IIIII 'Will 1 S o III � � ,i og o 1HHI WI II �I1, 111I! : z Y 1