HomeMy WebLinkAboutBLD2023-00732 - BLD CD Environmental Health Review - 6/29/2023 Alf
Permit No: (/((( 2OZ -Wei. " MASON COUNTY RECEIVE 4- COMMUNITY DEVELOPMENT
L' .``" JUN 2 8 2023 -Po
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Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION �G O
PROPERTY OWNER INFORMATION: • CONTRACTOR INFORMATIONW. nlder Street tn� v�
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NAME:-J I:V►ti,`� II— 7 NAME:
MAILING ADDRESS:I(Xa I Obi21- 5t- t MAILING ADDRESS:
CITY: i I (VIA ST' TE:WWA ZIP: '1&N5 CITY: STATE: ZIP: C
PHONE#1:.2 S 2,- `c'J0 I - 3 113 PHONE: _CELL:
PHONE# : EMAIL: = _
EMAIL:_ itaxr rye,tbK(y�'1r-via.0 .CG(Y1L&I REG# EXP. / / rn 0
PRIMARY CONTACT: OWNER CONTRACTOR 0 OTHER 0 Z
NAME EMAIL .171
MAILING ADDRESS t u-L- CITY STATE ZIP
PHONE CELL = Z
PARCEL INFORMATION: /� G Pr 0,..1.L LU-f"1 G1 --'i
PARCEL NUMBER(12 Digit Number) , i!2 -In= (OQ I I ZONING D
,, ) LEGAL DESCRIPT N(Abbrevi ed) I_tk .. iii1 '1 I�C #2. FIRE DISTRICT 6� r
V! SITE ADDRESS -At�F ,Lr/L E7((r.- C' CITY
(— ' DIRECTIONS TO SITE ADDRESS 0--.....v) IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO 0 SNOW LOAD:_psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all ihai apply).
t.0 SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
Z TYPE OF WORK: NEW / ADDITION 0 ALTERATIONGG❑ REPAIR 0 OTHER CI
USE OF STRUCTURE�((Residence,Garage.Commercial Bldg.Etc.) Jl
E
IS USE: PRIMARY SEASONAL 0 NUMBER OF BEDROOMS `,7 NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(Whole Bldg)❑ YES(Parr/s)of Bldg)❑ NO 0
DESCRIBE WORK nc,(,' SF e
SQUARE FOOT GE:(proposed) � nh.C�Gc�.rzi
1ST FLOOR ICi&sq.ft. 2ND FLOORJC _sq.ft. 3RD FLOOR 11 sq.ft. BASEMENT a 16 sq.R
DECIMte sq.ft COVERED DECK _ sq.ft. STORAGEIO''5 sq.ft OTHER sq.ft.
GARAGE sq.ft. Attached 0 Detached 0 CARPORT sq.ft. Attached 0 Detached❑
MANUFACTU RMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MA MODEL LENGTH
IDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 0 SEWE / NEW EXISTING 0
PLUMBING IN STRUCTURE? YES NO❑ /Jyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YEi.e
t-- NOD EXISTING SQ.FT.
EXISTING BEDROOMS 0 PROPOSED BEDROOMS \1 TOTAL BEDROOMS 5
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.1 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 pennit/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 3 S'- ature of OW R(Must be aimed by the OWNER) ate
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH MatZ
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