HomeMy WebLinkAboutBLD2023-00543 - BLD CD Environmental Health Review - 7/10/2023 IOC--
Permit No: D oC� �� 1
-r_0 ;`f. MASON COUNTYRECEIVED
,, R E
1 i'. a' - COMMUNITY DEVELOPMENT ENVI R
°_ = MAY 1 5 2023 ON!'�'1ENTAL
�' Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLIC151TAC AIaer Street HEALTH
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: L1- fe. 45
NAME• yl t-C•42_ NAME: CZUtJ
MAILING ADDRESS: , L/444E_PL., LA.,_ MAILING ADDRESS: -
CITY:� _STATE:c.. .44.ZIP CITY: STATE: ZIP: _ -' I��L�
PHONE#1: -'2_. 3- 39 - ct32-5 PHONE: CELL: LSu1J
PHONE#2: EMAIL:
EMAIL: L&.1 REG# EXP.—/—/ JUL 1 0 2023
PRIMARY CONTACT: OWNER 2' CONTRACTOR OTHER 0
NAME 444 �df,La EMAIL�A- 4E Ca) CSC.e- GLMJ4,' 44-71 RECEIVED
r
MAILING ADDRESS td ".EASE_ PL.Li., CITY'.,i 7Qp STATE(i-49- ZIPS
PHONE 2-S3 -3 3R- 325 - CELL
PARCEL INFORMATION: 7�,
PARCEL NUMBER(12 Digit Number)Z2C719
ZONING Qj j. _
LEGAL DESCRIPTION(Abbreviated)111 LA J nr 9 p _FIRE DISTRICT
SITE ADDRESS _ —FL-.1.CJ'----•---- -CITY 0 - --
DIRECTIONS TO SITE ADDRESS "�[n_ PCLL-4e-a D�iUE ?e- (L--5( LA/
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO Er SNOW LOAD: psf
IS PROPERTY WITHIN 200 Ft OF THE FOLLOWING: (clx.k all that apply):
SALTWATER D LAKE❑ RIVER/CREEK 0 POND 0 WETLAND❑ SEASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW 12( 'ADDITION ALTERATION 0 REPAIR❑ OTHER 0
USE OF STRUCTURE(Residence,Gorag.,Connnetrial Bldg,Eto,t' w —
IS USE: PRIMARY,O SEASONAL_❑ NUMBER OF BEDROOMS I NUMBER OF BATHROOMS 1
HEATED STRUCTURE? "Y�E�S(Whole Bldg)% YES UPati(sl of Bldg)0 NO 0
I' /11.4 DESCRIBE WORK cae' l4•a _44L,__- A-__ fitJ 21:13i a ia
SQUARE FOOTAGE: (proposed) e- •
AST FLOOR_2-44 sq.ft. 2ND FLOOR 6 sq.ft. i ft. -• - 'y "
(DECK' sq.ft. COVERED DECKSS/ Cq.ft. STORAGE _sq.ft. OTHER _sq.ft.
ARAGE sq.ft. Attached 0 Detacht,d 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 SEWER 0 / NEW J2( EXISTING❑
PLUMBING IN STRUCTURE? YES NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES D NO,Er EXISTING SQ.ET.(?"T/
EXISTTNG BEDROOMS PROPOSED BEDROOMS I TOTAL BEDROOMS I (( I
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 6 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 j
COUNTY CODE 14.08.42)
X _.... .„,..../4241,23
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 q
PUBLIC HEALTH ,IAA f l�