HomeMy WebLinkAboutBLD2023-00946 - BLD CD Environmental Health Review - 9/26/2023 •
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;,. .' MASON COUNTY
COMMUNITY DEVELOPMENT AUG - 8 2023
,. Permit Assistance Center,Building,Planning 615 W. Aldo WON
MENTAL
BUILDING PERMIT APPLICATION HE„_ TH
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:gQYt. c}e.-n n 1 Yl-CVS NAME:ZV•CAACAT\ W AA A-a-b
MAILING DRESS: MAILING ADDRESS: Ii'S3 l 5 J)
CITY: a.SY' STATE:W ZIP: g cITY:Tackm fit. STATE:wxt ZIP:d[VA
PHONE#1: 31aO-1/54-ITO.% PHONE: CELL: 1-2- 10-1.32_---P-OtA
PHONE#2: EMAIL: Br-trot... C ) mo-hcont - tow1'\
EMAIL: `Y10- A-LOY Y1 L&I REG# EXP. / /_
PRIMARY CONTACT: - OWNER CONTRACTOR El OTHER 0 — J, �M
NAME %Q�-- �Q..ri � ` J� EMAIL t011j, .ocrer C vt. -O LlIJ
MAILING ADDRE S* O CITY ? r STATE L I.XL. ZIP qf$* SEP
PHONE 24 4- - CELL 2 6 2023
PARCEL INFORMATION:
f i RECEIVED
PARCEL NUMBER(12 Digit Number) 3 e�t_10-a 3 -v`\� 1 ZONING 1 D
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRICT
SITE ADDRESS �bl t\tSlVp Q CA r1# Q4, _ CITY Shy}p'n
DIRECTIONS TO SITE ADDRESS
IS IRE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO SNOW LOAD:^psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all tharappt'y):
SALTWATER 0 LAKE 0 RIVER/CREEK 0 POND❑ WETLAND�J SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW7) ADDITION 0 ALTERATION 0 REPAIR 0 OTHER 0
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Eta) ? 5 c P`(1C
IS USE: PRIMARY rot SEASONAL 0 NUMBER OF BEDROOMS y NUMBER OF BATHROOMS 2.5-
HEATED STRUCTURE? YES(Whole Bldg) YES(Part(,)of Bldg)❑ NO 0
DESCRIBE WORK
SOUARE FOOTAGE:(proposed)
1ST FLOOR2(12A.\sq.ft 2ND FLOOR V sq.ft. 3RD FLOOR 0 sq.ft BASEMENT O. sq.ft.
DECK r5 sq.ft COVERED DECK_ .ft. STORAGE 05 sq.ft OTHER sq.ft.
QGARA( sq.ft. Attached Detached 0 CARPORT r sq.ft Attached 0 Detached 0
MANUFACTURED HOME INFORMATION: *4 COPIES OF nu,FLOOR PLAN REQUIRED*
MAKE YEAR LENGTH
WIDTIt S BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC,) SEWER❑ / NEW' EXISTING 0
PLUMBING IN STRUCTURE? YE :G NO 0 I yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION D S PROPOSED? YE NOD EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOM TOTAL BEDROOMS
OWNER acknowledges that submission of inaccurate information may result in a stop wo order or permit revocation.Acknowledgemeit 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
r t LICATI•• tt F 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
- COUNTY CODE 14.08.42)
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Signature of 0'" ' (Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIEDA. DATE TAGS/NOTES/CONDITIONSzr
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL r `A
PUBLIC HEALTH (Pzf_ p`f/23 l.{l ))) ociao..1,
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