HomeMy WebLinkAboutBLD2023-00751 - BLD CD Environmental Health Review - 7/7/2023 ---
PRIMARY CONTACT: OWNER M CONTRACTOR❑ , OTHER 4
NAME - e// c) 0 a( 1_ ~ i
MAILING ADDRE S % ) 3 CI 7/ RE ‘ ''� l '
PHONE_ 3Cc�L7 • —(Y17,5- CELL Xr 4YYLQ 20_
PARCEL INFORMATION: JUL 0 7 2023
JUL 05 � Z3
PARCEL NUMBER(12 Digit Number)J 2 3 7--v- IC CEIVED ONING _
1 W Ider Street a
LEGAL DESCRIPTION(Abbreviated) FII i?iSTI�3�
SITE ADDRESS (, I/ ,r7 k /97 ./' al. ` L'/ CITY 2 .� ?7'ZG?/(_ ( t()
DIRECTIONS TO SITE ADDRESS / v
-
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO SNOW LOAD:1Y psf `• J
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF 0 STREAM❑Cn �„ 7
TYPE OF WORK: NEW($( ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑ og►i
USE OF STRUCTURE (Residence,Garage.Commercial Bldg,Etc.) c C �"'$ JY /C;/J V 7C liiei, 4-MC '
IS USE: PRIMARY 0_. SEASONAL❑ NUMBER OF BEDROOMS . NUMBER OF BATHROOMS -_ �..:.m.7
HEATED STRUCTURE? YES (WholeBldg)0 YES(Part[s]ofBldg)❑ NO❑ i�•,(�[,9.v( .,n:
DESCRIBE WORK •P/(7(2 /7•!N.% 72.'Y,/1 v h2/7 ,-.-,,,-/ A i// e lJ>7 perm- 77r-'v)-7,--.4. A 5,
SQUARE FOOTAGE: (proposed)
1ST FLOOR /`f('1/ sq. ft. 2ND FLOOR sq. ft. 3RD FLOOR sq.ft. BASEMENT sq.ft. r
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq. ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
-MAKE 74,l( 424y1 t 1 CI MODEL I ILI S' 5-2`I f- YEAR : d; 3 LENGTH 5vZ
WIDTH ,-2 -7 BEDROOMS 3 BATHS SERIAL NUMBER 77'3I?
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC__ SEWER 0 / NEWS EXISTING❑
PLUMBING IN STRUCTURE? YES ❑ NO❑ If yes, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NOE' EXISTING SQ. FT.
EXISTING BEDROOMS 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
4 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 /E -dt/i 1�t Ti7lea .-1(; i'/'/1 6/)/ / >1!W_ 3
Signature of OWNS Must e si ed theNER to
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH °VA J-4.4 Cu itd;4 i.r..✓;
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