HomeMy WebLinkAboutBLD2023-00997 - BLD CD Environmental Health Review - 8/25/2023 E1 ci ZOZ3- 0099 f
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: GO 4 66 /f /6.dlir/s NAME: /Q/YA,tig&/ SeE�/
MAILING ADDRESS:2 810 ,E. Hit,//",6 Gv-zevy MAILING ADDRESS:2000 £9F 7ON 4t F" ti
CITY: i&F M1/1 STATE: a/A- ZIP: g.PS zP CITY: 5/9074rDN STATE:�jp ZIP: 9„Ps i>V
PHONE#1: 360 - 73/- 2? ?? PHONF36p-4/2?-4'y CELL: MO - c/90- 0,:7p
PHONE#2: EMAIL:i4rI (AR . Gov 0 r,t•uTioy %� etrii
EMAIL: IC4.74//64 (15 2 000 41 f/ti�seD:Gou-s. L&I REG# EXP. / /
PRIMARY CONTACT: OWNER ElCONTRACTO OTHER 0 RE C-P.I\IE U
NAME
E
MAILING ADDRESS CI �� STA E AUG 2 3 z1 23 cr
2 S 2Q23
PHONE CELL AUG F--
PARCEL INFORMATION: 61 W. Alder Stree , , -I
RECEIVED R R 2 D h-
PARCEL NUMBER(12 Digit Number) 2 z27 2- — /* — 9OQ -,
LEGAL DESCRIPTION(Abbreviated) 7w•y-,j crA E //Z "9C/0LG 4 FIRE DISTRICT G
OW
SITE ADDRESS JCPO f/,I/tr MOL/4W 1-4/ CITY ,AFL F/1/R rr.
DIRECTIONS TO SITE ADDRESS OPP DP 5-A I 0 4 I /fir`;//*U A/4/®f' As/N 4"
s-ro R E 2
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YESO NO[SNOW LOAD: ps
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK 0 POND 0 WETLAND L4ASONAL RUNOFF❑ STREAM 0
TYPE OF WORK: NEW er<DDITION ❑ ALTERATIONN ❑ REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc) /t D u
IS USE: PRIMARY [SEASONAL❑ NUMBER OF BEDROOMS / NUMBER OF BATHROOMS /
HEATED STRUCTURE? YES(Whole Bldg) YES(Part[s]of Bldg)❑ NO❑
DESCRIBE WORK
1)
...
SQUARE FOOTAGE: (proposed)
1ST FLOOR gig sq.ft. 2ND 4OQR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft. ..�
ot(.n
DECK sq.ft. COVERED BECK 1) sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED *4 COPIES OF THE FLOOR PLAN REQUIRED* 1
MAKE MODEL LENGTH U
WIrtiTH BEDROOMS BATHS SERIAL NUMB
til
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC 1!( SEWER❑ / NEW❑ EXISTING LJ
PLUMBING IN STRUCTURE? YES [V- NO ❑ If yes, attach completed Water Adequacy Form 0
PERIMETER/FOUNDATION DRAINS PROPOSED? YES ❑ NO[ EXISTING SQ.FT.
EXISTING BEDROOMS 2- PROPOSED BEDROOMS / 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 18 I DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
COUNTY CODE 14.08.42)
x �, .� - 6 - 23
Signature of OWNER ,ff;L•. signed by the OWNER) Date
�.. --- ............ I .......i..r.... I ...n,. I ....�Rr,n I ..•....+ I m.�nr tnmrfl,�+��rr.rr.��rn
x n '
{ 1 rn
L _ .n. t ® 1
co
4
$;gp t—
y
`A. d 6 -
Z Et2 s .
a ra
01
jG 7
' $ zv
/ a d 4..6'1;2
ti v w
D
Z
G p
pi( ;•7i} • {$ 8 i :E�0 z p gBQ al' rii
t1jr
11114111' 1111'. f €ti x ,} q I ik F7 !+ ^' fgi., i ,yy . ; }e • cy ¢ xg^9 S zs €x;"!}i i} %;) 2acis g O i V< r 2�1tx itii '�y0•�� xixt5�! R 'rn' � ; i s. 114 # t: ! 2iiL< fj x N}/; 1' at 1}#x ` io 1, 5 i N IE Z ii x # 6=111 ti � d � a• 'i�i' x '{ 41 }ii f I 1 ( O F c �t}ex c 11 '
ifiti 1 I iflt
1 11 1 Y 4 ' 0 A4t9$p !
i t ' 1
J = 5 � a i§oocimn �y Po rn yrn
i3 vo'oF,� E A A
o m 9;44- s Fin
w I nine" = g z
s D o ; g
3 o m 4g vo.. I <2Z
�N
o O &$% Q
tv
oC "1 od f 0
m g s 3 CI) _.
N 1,' 2g�
W £ 2
� _o
mo?
0
s n x
1 . . t1OMETOWN
1 T & i " i l COVER`SHEET 1 GEORGE 4 KAREN WIGGINS
/n " § , W/SITE PLAN w 240[Herr ra.wWut i
tlLI"It.WA ee57e oSOFti
"-Ip�'t INC < U I�;A
F 1•A
• 7 ' I WWI naxt WADER ': .n..mx"'r—..•�
r ._., ,
0 ,,.
(I,
Existin ' 1 , f
Septic Proposed
._ Tank Line
� 1
al _____,
R FYfe, I
Ai 5
1.5
tv
Pir4fAkt TAW.
Existing .. .
j Septi
1.1474144175
1.
0.00
1 Iv
I
W
I-
'1!
4
CC
I ww
0
a
co
CD
LPN to
3 CO
cv 4