HomeMy WebLinkAboutBLD2023-00641 - BLD CD Environmental Health Review - 6/7/2023 Permit No:S ,020423 _ 006,1i t
MASON COUNTY
COMMUNITY DEVELOPMENT RECEIVED
'C��'�- Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION JUN -7 2023 m z
PROPERTY OWNER INFORMATION: CONTRACTOR gvi'GI , er Street rn
NAME:.A o M et 5 tim Le Tr. NAME: IT p
CT ADDRESS: ,--/
I' ADDRESS: M E N TA 0
CITY: Si.) I {NG e'✓ STATE: L..)� Z�P: �j yt� MAILING STATES AV Q
PHONE 411: 34,0 --Li 0 .-jS-7 0 PHONE: CELL:
PHONE#2: EMAIL: HEAL! H
EMAIL: L&I REG# EXP. / /
PRIMARY CONTACT: / OWNER r$ CONTRACTOR❑ OTHER 0
NAME 1 &vl .m r7k l/ EMAIL 4e--v.k vdn,..t 11 1 334".7 3 6 g 1 I
MAILING ADDRESS / F. L.J. ll€1 (A,, CM >kc tA,Q.-t STATE %&\R, ZIP'( 'f'-
PHONE 3(00 —y'(o — IS 70 CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 3 200 3 - I I goo L4) ZONING
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 14 1 e. e,.5,I`el, Let. CITY She 67..1
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO lif SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK JO POND 0 WETLAND 0 SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW® ADDITION❑ ALTERATION❑ REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.pact Rt'S t(? 't(4
IS USE: PRIMARY❑ SEASONAL 0 NUMBER OF BEDROOMS Z NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Parris]of Bldg)Zs NO❑1 /
DESCRIBE WORK I-1o�IS e o'v" i e n/ (C.rel4 e ( Ltnr+e4ltc,d r.re.S.B)
SQUARE FOOTAGE:(proposed) J
1ST FLOOR /200 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK / .jL/ sq.ft COVERED DECK LQ sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE /2.4'C sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ 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 Er SEWER❑ / NEW❑ EXISTING jg
PLUMBING IN STRUCTURE? YES El. NO❑ If yes,attach com eted Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES 0 N EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS Z TOTAL BEDROOMS 7
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 pemnit)application becomes null 8 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 / C-1r4 07 s
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL B
PUBLIC HEALTH DA [5 j13 Co Rd 1'�4 S &y(h /,
ASIo..___I____21E__________
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g k;_nb'f; 4l.vr-10" loam 4-roas, EH SETBACKS
1111 A)Drainfield/Reserve requires 10'setback from footing/foundations
Pa r rf l `r 3 Z 00 3-1I-goal I i o-3 e` L5 T t O of S -to B)Septic tank(s)requires 5'setback from all footing/foundations
y l C)No foundation/perimeter drains within 30'down-gradient of drainfield/
/i VV 1 l)fI r Y) S Y'.1 COOlf p,(? j S reserve area
D)No cut(s),bank(s)(greater than 5'&over 45 degrees) thin 50'
yn v.6fri o u i o r+r oo-rS' down-gradient of drainfield/reserve area
SCa1f. = -io 10-3;t1 I S-}FOOTS 40 EH APPROVED
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