HomeMy WebLinkAboutBLD2023-00736 - BLD CD Environmental Health Review - 6/29/2023 Permit No:S l A 2UO1�- Oo1 1-(
.. ,,„ ` MASON COUNTY
r y, COMMUNITY DEVELOPMENT RECEIVE
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION JUN 2 9 2023 lio Gr''' �
PROPERTY OWNER INFORMATION: CONTRACTOR INFORj tI ; Alder Stre: F ,,
NAME: KI=N'- CC(Z4VI A NAME: GII\
MAILING ADDRESS: PU 331 S MAILING ADDRESS:
CITY:VeNrrO 1J STATE: teJ(a ZIP:9$O S 6 CITY: STATE: ZIP: _
PHONE#1:&)(7- LIP 6- 4101 PHONE: CELL: /ii•
PHONE#2:a t)b -19.S-- 9.05u EMAIL:
EMAIL: p-C-Ctc EL iOM her.%4AQ.t on.. L&I REG# EXP. / /
PRIMARY CONTACT: OWNER.& CONTRACTOR 0 OTHER❑ = _
NAME EMAIL m 0
MAILING ADDRESS CITY STATE ZIP
PHONE CELL > z
PARCEL INFORMATION: i
PARCEL NUMBER(12 Digit Number)a 1 0 S - S 0 - 00001'\ ZONING 22- S Z
LEGAL DESCRIPTION(Abbreviated)MA00%06S SJlii.P ISMo/_ 'IQ- 11 FIRE DISTRICT —1
SITE ADDRESS ,\‘1 le I-1,PcSe,J likicc OIL e. CITY 6,944PEV%t�LA) D
DIRECTION TO SITE ADDRESS W Pt -3 N ( +urn On cletSorr loon Non rol e r
-lure. V On V HAS&0 Latkv z Ott- L
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: (C'heck all that apply):
SALTWATER D LAKENr RIVER/CREEK D POND❑ WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 0. ADDITION❑ ALTERATION❑ REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc.) SF R
IS USE: PRIMARY SEASONAL 0 NUMBER OF BEDROOMS Z NUMBER OF BATHROOMS Le
HEATED STRUCTURE? YES(WholeBldg)i, YES(Pail(s)of Bldg)0 NO 0
DESCRIBE WORK 44E. 3-ilu'y LALQt4E1.7T Si----
i.g r SQUARE FOOTAGE: (proposed)
T FLOOR itgjn sq.ft. 2ND FLOORPO 6 8 sq.ft. 3RD FLOOR 617 sq.ft. BASEMENT sq.ft.
DECK_as a sq.ft. COVERED DECK 3 )I sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE61 sq.ft. Attached\Detached 0 CARPORT sq.ft. Attached 0 Detached 0
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 SEWER❑ / NEW EXISTINCy
PLUMBING IN STRUCTURE? YESX NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YESX NOD EXISTING SQ.FT.
EXISTING BEDROOMS 1. PROPOSED BEDROOMS 2 TOTAL BEDROOMS Z
OWNER acknowledges that submission of inaccurate inforrnation 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 descrioed 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 �- g(„74,(_,(____ C ), Z 3
S' nature f OWNER(Must be signed by the OWNER) /
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL PUBLIC HEALTHf)IP 9f(f i'/�
6 ,202•3 - 66(3r 7o
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PROPOSED RESERVE AREA 300 S F+ I -_ <lkF
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APPROXIMATE EXISTING ',
DRAINFIELD PER RECORDS \ \\
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MA
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NMvEN/ APPTEN/ EXISTING TRANSPORT • \
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l \ APR f 7 2023
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I EXISTING �
EtAI DHEALTH
ET
I WELL I ,
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PROPOSED RETAINING WALL ��1` I�_ 1 ,I, ;
BEHIND NEW GARAGE IV .. 1
it I / �'•
PROPOSED 1500 SEPTIC TANK / I %! .r. • '
& 1500 PUMP TANK __ . —
I _-j // EXPIRES
1`-i_- ,/
EXISTING TANKS ---1 -- I I 4__,L___
TO BE PUMPED & -1-\ / \\
ABANDONED PER CODE '*��\ I PROPOSED ADDITION
/ 1_I ��•\\., • I 1 \\ \\
EXISTING HOME
i W/DECK - -, \ 0 ,\� \
I // , I I 1 \i EXISTING WELL
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1 APPROX. �D �� � ► I I
OF LAKV \ / I /
\ \ / / / /
\ \ \ \ / i
AN ASBUILTI INSTALL SIGNOFF FEE WILL
\� \!\ Y� / BE CHARGED AT TIME OF INSTALLATION
\ \ \ - \
[NO i k`f HOLES PROVIDED. HISTORY��F AREA l�
C.IL�i JMER: KENTCOR REA YPE 3:LOAMY TO UVIDE:M SISTU
PIONEER DIGGING, INC. LIS I a.»n COO
NDS
SEPTIC DI.SIGNS ADDRE_S.S: UII E MASON LAKE DR E
DE:IGNER: ROBERT H.PAYSSE cLN T/Y■NOTA$( YET.NERNENCE$WRUOE CINC"'rcouVryvNovrlE.DRD; CRAPFI'IEY1,�1'A9R5'IC, AT$ON vafElOIS.NE�ENT$ Cws DENTE °OA*SOC3tk1 L 1MX�1 E MS /sroaEE o�av NEW CEO oERKA Rese r,v of swcCT RE DTKNMt"' :360-4261B03 FAX-36(�-427 2353 �IiU L: SITE PLAN SCALE r=`0' VARt11ENIow,' Y NENEw CE0GNER NOT MFAT %N E•ON sETM IE u O on t0
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