HomeMy WebLinkAboutBLD2023-01032 - BLD CD Environmental Health Review - 8/30/2023 Per it No: [J 1 d o a s010 2 1
' MASON COUNTS • t ki,COMMUNITY D E 0�'� i RECEIVED
Permit Assistance Center,Building,Pla AUG 30 2023
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATI6:5 W. Alder Street m
NAME:M;ke 4.•_BecK� f(SQn NAME: HAs N /4w!{ Bli let's LI L Z
MAILING ADDRESS: 3a�5I4 J jot S MAILING ADDRESS: pp 6p 2 Z C
CITY: _„ . . - STATE:Wilt ZIP: 98003 CITY4trit Qt%MCw STATE:wA ZIP:98 5.40
PHONE#1: PHONE:3VO' D-/9rtELL:
PHONE#2: 2446 — SS niz.evike EMAIL: �(�4 h�qi►t u j/Qi:i►S IL(JSrhw,t°�,co... m 0
EMAIL: /'MJK0 Co ug s 1c L I REG# Nf4S/tEl 1 74/KlEXP.�i ji o 5" > Z
•PRIMARY C NTACT: OWNER❑ CONTRACTOR XI OTHER❑
NAME A lot EMAIL N,►rti k.wlcd V-Lfrie.T414401/II,Co� rn
MAILING D RESS Boy 71 CITY 6, ' STATE4l.1Z1P Z
PHONE CELL
PARCEL INFORMATION: Z rD,.
PARCEL NUMBER(12 Digit Number) 3 '0'1 00 0/o 7 ZONING Nei
LEGAL DESCRIPTION(Abbreviated)Agabrook G¢)/.bt/-rR 7D3 FIRE DISTRICT
SITE ADDRESS /c't E W e....5404val L N E CITY (,W h, Vl
DIRECTIONS TO SITE ADDRESS -
N.oM E Mcgfvrii Rd, E. pi- r N1aaivt t.i p•M dlr� 4. 0.. F.arw LN., f, oK
IS THE PROJECT WITHIN 36(1 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO SNOW LOAD:Lpsf F.we...W JA
IS PROPERTY WITIIIN 200 FT OF THE FOLLOWING: (Check all that apply): /
SALTWATER 0 LAKE 0 RIVER/CREEK❑ POND 0 WETLAND❑ SEASONAL RUNOFF❑ STREAM 0 To� �e4 0-
TYPE OF WORK: NEW je ADDITION❑ ALTERATION 0 REPAIR❑ OTHER 0 Ro_.-1
'
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc)
IS USE: PRIMARY RI SEASONAL 0 NUMBER OF BEDROOMS 2 NUMBER OF BATHROOMS 3
HEATED STRUCTURE? YES(Whole Bldg), YES(Parris]of Bldg)0 NO❑
DESCRIBE WORK p� �) [�y�/f G�tl/'O 9 �' �.V C7arek.
SOUARE FOOTAGE: (proposed)
1ST FLOOR_/ .2sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED DECK ,r?O� sq.ft. STORAGE sq.ft. OTHER _ .�q.ft.
ilea
GARAGE O sq.ft. Attached® Detached 0 CARPORT sq.ft. Attached❑ Detached❑ 1
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE MODEL LENGTH
W H BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC$ SEWER❑ / NEW ri EXISTING 0
PLUMBING IN STRUCTURE? YESRI NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES$ NOD EXISTING SQ.FT.
EXISTING BEDROOMS D PROPOSED BEDROOMS Z TOTAL BEDROOMS Z
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 8 void if work or authorized construction is not commenced within 180
days or if construction work is suspended fora period of 180 days.
PROOF OF FO TINUATIO OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT PP ICA I F 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X
gnatu of OWNER(Must be signed by the OWNER) Date
DEPA NTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL 'US C�
PUBLIC HEALTH � �� �� �� '�,tom)"`�'"
.' ...7:.''.....i:.:1:4: .•
pot51 i
,\, vas
<,.‘"\.\\.$\ 0,
a:9‘' V ''S% S
\ � " \
•
1
, , .. .. . iY.'"
N v 3
p Y
•
s QQQ g O;.O (n 71 , r # ,tis.
T ^ M.
9 D) 1 ci) CD Q Cn N (
m i pn 90 � N O
4 "d \ C) O z
o X O
O D2. n
p
< c4SvQ D c-oCO`
CpQO
COCCI x
0_
C7 ="`G CD agS v o0 C\D
+
> O LnFIr 70r� g� Q
-: a. E � N
< OCA > J vv 0w p z o
_ •C ^ N . .. ..Zz�v
.ca 2,om O < , g2a.?
0 co ) er dmHwxla
C co Nz -�o
Cn Cn m g
o o d8mm„$ m
�„ m m . S
U, E. i> •C
Cn
a D II' �' 4a- N
J, o gd q "'
0 3 � zv 606 d
( Q � Ti o 71 m< w d x A
0 - Q. ' 0 da �a
y < * o -n $3 co
i Q CD m m $ i g
o
cog. 3=-8
9B�
II
10
"j'
'... ._. ..,,,:...-1..,.. - -i -' ,. . ______.„. Z,„ , ,b