HomeMy WebLinkAboutBLD2023-00544 - BLD CD Environmental Health Review - 7/10/2023 &6- 0-0--)f-- A&V;kty-
Permit I No: a(/O V 2) 6 05-1-11-1
MASON COUNTY E C _IV ED Lea
) T
COMMUNITY DEVELOPMEN
;; ,j Permit Assistance Center,Building,Planning MAY 1 5 2023 JUL 1 0 2023
BUILDING PERMIT APPLICATION
`n1 q��j cr tree RECEIVKI
PROPERTY OWNER INFORMATION: CONTRACTOi ATA) A'Z'iON: ��
NAME:,WWtyl�jri_c42. NAME: eitiA ) l� C
MAILING ADDRESS = 7J
• L,�,E�L f..t_J. MAILING ADDRESS:_
CITY: STAT ' L44 ZIPgcc CITY: STATE: ZIP: _ m O
PHONE#1: CIS 3-__3g- q32.,, -_ PHONE:- CELL: D Z
PHONE#2: EMAIL:___
EMAIL: _ L&1 REG# EXP. / /_ r,,,I K
PRIMARY CONTACT: OWNER 2.. CONTRACTOR OTHER❑ = m
ME NA X)I4 �L4 EMAIL. �—L CSG Lv G7LM,"Lf-QV✓J Z
MAILING ADDRESS �__.MS, PL..w CITY ..t'.Pfeq..T STATE,(.t-4 ZIP —"I
PHONE 2-53 -?i 39-,(- CELL ---. r
PARCEL INFORMATION: � 7�
PARCEL.NUMI3ER(12 Digit Number)LeZ �JI r ZONING .
LEGAL DESCRIPTION(Abbreviated) [ L I R4, FIRE DISTRICT
SITE ADDRESS % ,g. L.
.. 1, CITY FL - - -
DIRECTIONS TO SITE ADDRESS "G'Avg gl-�A�'�Z I)Q.4U . -Ca- C64-SI`Z isL, C.t,
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER TITAN 14%: YES❑ NO Er SNOW LOAD:.^psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all dntoppiv/:
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND❑ WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW 'tADDITION' ALTERATION 0 REPAIR 0 OTHER 0
-) USE OF STRUCTURE(Residence,Grange,Cotmnv.rial Bldg,Ete.)&4 .1y-1A ft. .
IS USE: PRIMARY,,SEASONAL 0 NUMBER OF BEDROOMS— I NUMBER OF BATHROOMS OMS i
HEATED STRUCTURE? YES(Whole Bldg) YES(Pon(sj ojBlda)❑ NO❑ i ��
DESCRIBE WORK' 44/4 23clug IJ ? 1`-L5,t D a
SOUARE FOOTAGE:(pnq,o.d)
ST FLOC _sq.ft. 2ND FLOOR . sq.ft. LOORj�%sq.ft. qt l sq.ft.
DECK —sq.ft. COVERED DECK 5J q.ft. STORAGE _sq.ft. OTHER —.-sq.ft.
ARAGE sq.ft. Attached CIDetached 1-".
MANUFACTURED HOME INFORMATION:
CARPORT ,sq.ft. Attached❑ Detached 0
*4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL YEAR_ LENGTH
WIDTH BEDROOMS __— BATHS _SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 / NEW EXISTING 0
PLUMBING IN STRUCTURE? YES d NO 0 Ij}:es,attach completed Water Adequacy Form l
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO� EXISTING SQ.FT /IU'TJ�
EXISTING BEDROOMS PROPOSED BEDROOMS 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 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 structures)for review and inspection. This permit/application 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
PE IT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X S/Pu122
ignature 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 1/0;