HomeMy WebLinkAboutBLD2023-00774 - BLD CD Environmental Health Review - 7/10/2023 MASON COUNTY Permit No: ter:o, -3 Oo1�]�
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COMMUNITY DEVELOPMENT -}-
Permit Assistance Center, Building,Planning AL N
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: /1 I ` _`'
NAME: N o U;I 1 a to v NAME:Sc� laVAt1 'Qec�v,.S !J 1 t� k ( s 11,C,
MAILING ADDRESS:7701 Aa,i.AAAov. 4tf'p MAILING A`DD SS:IlsI t Soo' 1'Rd
CITY: E wt.r cYr STATE:1,... 0. ZIP:Mil o 1 CITY:Rocks STATE:14A uZIPCirdr)C
PHONE#1:4 2.5- -Lc t% -5\,.N 4 PHON CELL:/60-101-coo -RN.
PHONE#2: EMAIL: roc,... ;N Worit3 w.s.ri.cA►iek
EMAIL: ,N 4.L.V Go I.1.k•tem L&I REG#Cc-g001 E134S110CA -3ru /IS J U L 1 0 2023
PRIMARY CONTACT: OWNER❑ CONTRACTOR OVER OK
NAME-3-4.V. Lova1 EMAIL,roC si-ttcdir'1-WO( Q �''C•1 ' '4aw' RECEIVED
MAILING ADDRESS\\a\a SI'.r�•�k KA CITY I�ael...S� STATE fe ZI �
PHONE CELL SILO-.ol -0315
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number)22.61 VS'La40b4 ZONING
LEGAL DESCRIPTION(Abbreviated) //�� FIRE DISTRICT
5J SITE ADDRESS '\\ 'E P% KGl,� CITY r4,t.oh
DIRECTIONS TO SITE ADDRESS Q A. tjt E AAA-3 Ort-IL E Ao tic 12o( L or, S4
A� su I I E A5,�-1�- v
IS THE PROJECT WITHIN 300 FT OF SLOPES)GREATER THAN 14%: YES❑ NOV SNOW LOAD• S psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RTVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW,KJ ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence.Garage.Commercial Bldg.Etc.) et.t if_Lis...{
IS USE: PRIMARY' SEASONAL❑ NUMBER OF BEDROOMS .*3 NUMBER OF BATHROOMS 2
HEATED STRUCTURE? YES(Whole Bldig,gr YES(Pants/ofBld ❑ NO
DESCRIBE WORK =+nS .ea) 4e.N.) moir•AA J .1r•n1j
SQUARE FOOTAGE:(proposed)
1ST FLOOR I I I sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK GA sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
4 GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE CtrwU. 'A\Ipp,r. MODEL QQ� Afyt S YEAR 2.0 LENGTH yg
WIDTH 2) BEDRdOMS .3 BATHS 2 SERIAL NUMBER A/
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC( SEWER❑ / NEW ' EXISTING❑
PLUMBING IN STRUCTURE? YES NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ N(' EXISTING SQ.FT.
EXISTING BEDROOMS 0 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)
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Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH // W14 f-4-c. f 6
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