HomeMy WebLinkAboutBLD2023-00684 - BLD CD Environmental Health Review - 6/20/2023 MASON COUNTY
COMMUNITY DEVELOPMENT JUN0
2 0 2023
Permit Assistance Center,Building,Planning 1
BUILDING PERMIT APPLICAfiv W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR1
INFORMATION:
NAME: �u?'Y)SDs2. 1i?I(4d NAME: V r ki e j/
MAILING ADDRESS: MAIL G ADD S: fJ (/ //Z
CITY: STATE: ZIP: CITY STATE: ZIP: 3
PHONE#1: PHONE: IC LL:
PHONE#2: EMAIL: 6t/s tit of i✓? ,cern
EMAIL: L&I REG# . D Z9'_d / EXP. Y / / /Z'/
PRIMARY CONTACT: OWNER 0 CONTRACTOR g OTHER D
NAME lad &cG,le-1 r ,9, EMAIL r 0• i hbui/Ce(-4-(•)r t/f •Coy
MAILING ADDRESS Z91ui Nl'il Acid ha k7JI FG1/IfZ.CITY • STATE WL} ZIP 9g3&3
PHONE ,36Q- i 1-7 71 CELL r " ' .�„ ON M E NTAL
PARCEL INFORMATION: ^HEALTH
PARCEL NUMBER(12 Digit Number) ZZ1O S'SD..go 00$Y ZONING /-� f 1
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS 931 51 /I1asOn. LK e� tra p lil t W CITY 13r tfX vie w
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO til SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE® RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW CM ADDITION❑ ALTERATION 0 REPAIR 0 OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) )yl� /)7I:1U/^JW.{_de
IS USE: PRIMARY❑ SEASONAL aa NUMBER OF BEDROOMS .,? NUMBER OF BATHROOMS 2--
HEATED STRUCTURE? YES(Whole Bldg)IA YES(Bart(s)ofBldg)0 NO❑
DESCRIBE WORK
SOUARE FOOTAGE:(proposed)
1ST FLOOR I1 Z.O sq.ft. 2ND FLOOR 6 r73 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK 2S0 sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached 0 Detached❑ CARPORT sq.ft. Attached 0 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 9 SEWER❑ / NEW❑ EXISTING 61
PLUMBING IN STRUCTURE? YES RI NO❑ If yes,attach completed Water Adequacy Form
PERIMETERJFOUNDATION DRAINS PROPOSED? YES 0 NOD 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
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)
Signature of OWNER(Must be signed by the OWNER) L.{/ J Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL 'J
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V\\\// k}ASONCOUNTYENVIRONMENTALHEALTH t)wRES
MASON LAKE Jgw
AN ASBUILTI INSTALL SIGNOFF FEE WILL
BE CHARGED AT TIME OF INSTALLATION
C.l1WTC)MER: HARRISON LAIRD TE PULE k TE-r HOLE 2 TEST HJLE 3:
PIONEER. DIGGING, INC. PARCEL>� zzo5 50-00034 ° n` TILL 19+ u`
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PIONEER DIGGING, INC. PARCEL
CUSTOMER: HARRISON LAIRD TEST HOLE t TEST HOLE L• TEST HOLE 3:
0-30 GLS
2215 So-00034 30-30
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SEPTIC DESIGNS ADDRESS: 931 E MASON IX DR E
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