HomeMy WebLinkAboutBLD2023-00489 - BLD CD Environmental Health Review - 5/15/2023 `f s' • MASON COUNTY Permit No: Y)1`lii)e I� J p
K.4. COMMUNITY DEVELOPMENT
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'� Permit Assistance Center, Building,Planning MAY 05 2023
BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:% US i & ', NAME:
MAILIkG ADDRESS: D X I V' MAILING ADDRESS: m
CITY:it/4 MARD STATE: 1, ' ZIP:9g264 CITY: STATE: ZIP: Z
PHONE#1: PHONE: CELL: __ __
PHONE 12• EMAIL: ..�.
EMAIL: ii >v&S ' e • 3 (O ILA• • e hi L&I REG# EXP. /_/ = ,J1J
PRIMARY CO TACT: ,j pp�OO�W��NER❑A CONTRACTOR❑ OTHER m Q
NAME • DIVE 'ICk RY,LLV I-RN\1 5,{LA
EMAIL I 9 Z
MAILING ADDRESS 1 D E}( 42q I CuTY/ ��T STATE W4 ZIP g3
PHONE CELL\ Q�
PARCEL INFORMATION: g
Z
PARCEL NUMBER(12 Digit Number) 22.114`76-900 71 ZONINGJe L j'—rj'k_
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT .3 r
SITE ADDRESS X CSC E, k L 1-12: l CITY t j'/ PE✓iEW
DIRECTIONS TO SITE ADDRESS A Aa,
L
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO� SNOW LOAD:Z�7 psf VA f
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply): L p-->
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑ VA
OCZ
TYPE OF WORK: NEWS, ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) /Dr Al CC
IS USE: PRIMARY NI SEASONAL❑ NUMBER OF BEDROOMS 3 NUMBER OF BATHROOMS h
HEATED STRUCTURE? YES(Whole Bldg)X YES(Part/sj of Bldg)❑ NO❑
DESCRIBE WORK N! kfAi1,it=ACmgE1 hiPM5 d S .-Pr t SYgal egWe.:: Su/CZ a2 -D'3a07I)
SOUARE FOOTAGE:(proposed)
1ST FLOOR I U"21..1 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. .4ttached❑ Detached❑
MANUFACTUREDJ HOME INFORMATION: �1 *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKT l% /�} •TIOI'I 1 MODELVREAAII gli.I 1 YEAR 2G 2 3 LENGTH (jD1"
WIDTH G/-'I BEDROOMS 3 BATHS Z SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEWXI EXISTING❑
PLUMBING IN STRUCTURE? YES y( NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO$ EXISTING SQ.FT. 0
EXISTING BEDROOMS 0 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.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICAT)ON OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
1.X2,24,.cy /4.6. COUNTY CODE 14.08.42) 262,3
Signare of OWNER(Mtsvt be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH P Il Ir lam
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