HomeMy WebLinkAboutBLD2023-00960 - BLD CD Environmental Health Review - 8/14/2023 Permit No: 8W r 00 / Q
MASON COUNTY ' /7�'��
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COMMUNITY DEVELOPMENT
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Permit Assistance Center, Building,Planning '�-'
BUILDING PERMIT APPLICATION 615 W. Alder Sfre O
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION: >
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NAME: Hid
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' I-u' ,W��j/ L-�- a 1-_ / NAME: �(Z Vt,t v1`f'f r
MAILIN AD RJSS: /S, 7 G!J / r ' MAILING ADDRESS: /
CITY• • t.. STATE: ZIP: {CZI/CITY: STATE: ZIP: _ X Cn
PHONE#1: -• s--gc 9Y/T—T I PHONE: CELL: Z
PHONE#2: _ EMAIL: _ ZI
EMAIL: L&I REG# .) EXP. I/ ' D
PRIMARY CONTACT:„ OWNER CONTRACTOR❑ OTHER 5cc5���� r
NAME L /leEtj Irhu/iC( /et c !1 f(7/y17/A EMAIL vP L,�f//I(��/'/1i!•� C�'9mr4",(Glt'L
MAILING ADDRESS 1y"�3 d• (Y1etrKi.f- 4.1y T f, CITY n/P1"Y( STATE LIM— ZIP cif
PHONES?(;p-5 7d i./ f CELL
PARCEL INFORMATION: / •
PARCEL NUMBER(12 Digit Number) 3/CIO`7 53OC)2//*_ ZONING
LEGAL DESCRIPTION(Abbreviated) re:ICU/1 Z.C.a. *N .7. r7( FIRE DISTRICT
SITE ADDRESS-;g G t CITY - fCr-- ��
DIRECTIONS TO ITE ADDRE ��,, V: 5 6 i J` I�9
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO VNOW LOAD:)6 psi
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK 0 POND 0 WETLAND 0 SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK: NEW'I 'ADDITION❑ ALTERATION❑ REPAIR 0 OTHER 0
USE OF STRUCTURE(R idence.Garage,Commercial Bldg.Etc.) A. Oar,,C
IS USE: PRIMARY Q SEASONAL❑ NUMBER OF BEDROOMS NUMBER OF BATHROOMS .
HEATED STRUCTURE? YES(JVholeBldg)Of (Panlsl feidg)0 NO 0
DESCRIBE WORK fAIL& S F�-,Z rc m r/ ilalL .
SQUARE FOOTAGE:(proposed)
1ST FLOOR L 0 sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft
DECK sq.ft. COVERED DECK sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE sq.ft. Attached❑ Detached 0 CARPORT sq.ft. Attached 0 Detached 0
MANUFACTURED 'HOME/ INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAKE � , "iC 7'6 MODEL (,/ /D YEAR del: 3 LENGTH 'T
WIDTH ,--)2, BEDROOMS 7 BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER 0 1 NEW EXISTING❑
PLUMBING IN STRUCTURE? YES NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NOer EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 3 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 CONTINUAT N F W ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPL C 180 YS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
/ COUNTY CODE 14.08.42)
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Signatur of OWNS Nust be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL [
PUBLIC HEALTH 1L �CD193 Ccv c c
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