HomeMy WebLinkAboutBLD2023-00749 - BLD CD Environmental Health Review - 7/7/2023 MASON COUNTY Permit Nei i11,2Cs,17i-L014(.1
.'j - ) COMMUNITY DE``ELOP AE '' E C E I V E D
Permit Assistance Center, Building,Planning JUL O 7 2023
�E IVED JUL 05 2023
BUILDING PERMIT APPO ICA7'1tg
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMJATIOr�5 W. Alder street
NAME: L2'�}1-A\ 1. I PP N W :.L C NAME:?eta((Q C 6 ns+-ruc t r l rn
MAILING ADDRESSI U• v'IC ` MAIL�TG ADDRESS�I(-16 is m S � Z
CITY -V.._'N`,�c y STA � ZIP: R,� CITY:YOr�--jj�r(rrlll STATE:( A. ZIP: 1(s?(
PHONE#1:�,C,22-'�C,- 9C) ' PHONEr6 ..-2.,?c,--y CELL:
PHONE 2: EMAIL n,f�ct.CUi,6r,4- -F''ISf13t4S err a�I •Cd'r"t = II
EMAIL:6\c'\r,SL(!C\� 9(A1-\Ci;fb V$ jdo\L&I REG#fires n . 1X10Kt-( EXPYd/f1G/ad..?2J-( m c
PRIMA1Y CONTt )i CT: OWNER❑ CONTRACTOR, OTHER L 16C C4'r•(1'1(t '�
NAME l f)(L.l '�DY\'C _?r.✓ i EMAI 1 '(\G( VZtor'ts'ffoK.lilrf`47 , jMAILING•4DD. ESS 6i(.) fY�j S - �'Y CITY ' \A n' ATE ZIP�_ d j v 0 _ rm.
PHONE d67,5-7rJ. - - CELL z
PARCEL INFORMATION: {�
PARCEL NUMBER(12 Digit Number)��0 t O - 5 k- co(]t Q iQ ZONING k 1r-.6 r—
LEGAL DESCRIPTION(Abbreviated),�1 tYV-;y \(h YL k•'vC: li,t.0>i ll j Zr k fig'DISTRICT
SITE ADDRESS^'J 4 Car ?( `J.) I (tV^� ^ CITY S4', \k-O.n
DIRECTIONS TO SITE ADDRESIYY`,lI.,r1U- r(,Y1� , 0 4ib+jJ -k-Q e. , ) on �a(f-10 la, t{'e?\r�.I
cA w �. ht o . ors ..0 .rr pa o.c*- t 1,� - n(e 0 . `
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ Nod] SNOW LOAD: psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Cluck all that apply): •
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW, ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg.Etc) (Z-Q ,',t NCp,(
IS USE: PRIMARY$ SEASONAL❑ NUMBER OF BEDROOMS -,& NUMBER OF BATHROOMS 2-
HEATED STRUCTURE? YES(WholeBldg)I YES(Perils]of Bldg)❑ NO❑
DESCRIBE WORK l 1^,S• OA\ (`9..kk) cc (1. .(*f 0 C-t v2 C k `rx 0 C(\
SQUARE FOOTAGE:(proposed)
1ST FLOOR$, 5cLQ 6sq.& 2ND FLOOR)(A sq.ft. 3RD FLOOR 1A sq.ft. BASEMENT kl IA sq.ft.
DECK 3(.P sq.ft. COVERED DECK A sq.ft. STORAGE Pik sq.ft. OTHER sq.R.
GARAGE fV IA sq.ft. Attached❑ Detached❑ CARPORT 11J 1 pr sq.R Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*(
MAKE ` M,V1 Ai bCkr‘k*-- MODEL�'t Ik SQL YEAR L,'l LENGTH� S1 1
WIDTH AI" t BEDROOMS 3 BATHS a- SERIAL NUMBER I, B Z.)
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC® SEWER❑ / NEW X EXISTING❑
PLUMBING IN STRUCTURE? YES'NI NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOil EXISTING SQ.FT. N I A
EXISTING BEDROOMS J I A. 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/appiication becomes null 8 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) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH lu, / 1�04
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