HomeMy WebLinkAboutBLD2023-00855 - BLD CD Environmental Health Review - 8/1/2023 k MASON COUNTY Permit No: i� lc �t D
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JUL 25 20
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�� ��'' BUILDING PERMIT APPLICATION 615 W. Alder et
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:0 NAMEr:V >e.� , /Mt S e D G.P E LM g elir NAME,:5 A al �
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q) MAILING ADDRESS: eii3 if rx ,l /...,_,/...,_,ec MAILING ADDRESS:� H.q l3 71t AVE' w Vv
CITY:S&i j L t STATE:+i.eR ZIP:g4/ /1 CITY:S cI i i 1.g STATE:tom} ZIP: g�1 i/ R ,ZO?3
PHONE#1:S''v el 44,6 % - S 1-5 I PHONE:.3d g 'W So►CELL::a v0, 3 3 v y.?70 FCF�
'0 PHONE#2:.�L 33O NP2 v EMAIL:CG2q.2ND.wt, 4L� cv 0VfRue. et II/6-0
EMAIL:LL2.AR N ^"�S L1-� 01)-71pptcL&I REG#?Ail V°51 '71421 .KT EXP. S i I,;
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PRIMARY CONTACT: OWNER K. CONTRACTOR❑ OTHER❑
NAME �% �7 EMAIL<67 A 41-fJ D---e, 1-Le- )DU r L- t� Z 0 "-(
NiMAILING ADORE S a9 j.. A/t.J yA.v t7 C- lz.13. CITY 400-17 f D STATE c✓4 ZIP I g'5'7
U PHONE CELL
U PARCEL INFORMATION: I'n O
PARCEL NUMBER(12 Digit Number) 1 2 7 51 - 0 0 0 S 1 ZONING > Z
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT q rn
SITE ADDRESS 4. / E , t,v e tL J � i 7" ,_ CITY6 ILA?G Et,—;V7 E
DIRECTIONS TO SITE ADDRESS hi t^)j 3 5. i o {4 Rfi�a f Al) , � - t- Ca D ' 0 __ Z
I1t(pt4T '-o £ Ld7N 0 Li-7— c_i` (, o IL1t�r-f,"
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NOC SNOW LOAD:_psf D
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply) r
SALTWATER❑ LAKE 0 RIVER/CREEK 0 POND❑ WETLAND 0 SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW Virs. ADDITION❑ ALTERATION 0 REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Etc.) 1Ze.'i/ h.a..".."--G E
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IS USE: PRIMARY M SEASONAL❑ NUMBER OF BEDROOMS_ 4 NUMBER OF BATHROOM: 3
7----
HEATED STRUCTURE? YES(Whole Bldg)13 YES(Palls)of Bldg)❑ NO❑
DESCRIBE WORK,.r LEA.> ,-e?•!-j ZL VC? t TJ A% 5 T I CK a U/ 1-
S9UARE FOOTAGE: (proposed) -nis hie'
1ST FLOOR i OC,0 sq.ft. 2ND FLOOR_ )sq.ft. 3RD FLOOR sq.ft. BASEMENT IOW sq.ft.
DECK l 38 -sq.ft. COVERED DECK 105 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE lI y 3 sq.ft. Attached gis Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURE ON: *4 COPIES OF ILIL FLOOR PLAN REQUIRED*
MA MODEL LENGTH
TH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC❑ SEWER/ / NEW% EXISTING❑
PLUMBING IN STRUCTURE? YES Q� NO 0 If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES/ NOD EXISTING SQ.FT. I
EXISTING BEDROOMS Q PROPOSED BEDROOMS 4 TOTAL BEDROOMS _
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 dedare 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
r COUNTY CODE 14.08.42)
X_( G -73 2DaZr5
Signature of OWNER ust be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL PUBLIC HEALTH it Wit lit A
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