HomeMy WebLinkAboutBLD2023-00904 - BLD CD Environmental Health Review - 8/25/2023 Permit No:g7LQ(rl,() J' 00gO9
MASON COUNTY RECEIVED
COMMUNITY DEVELOPMENT
Permit Assistance Center,Building,Planning AUG - 1 2023 ENVIRONMENTAL
BUILDING PERMIT APPLICATION AlriPr Street HEALTH
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: Z) 55f. C-et RP2.14-1"MX NAME: (�
MAILING ADDRESS: 883(o tJ t,D(50N W.ST MAILING ADDRESS: u11
CITY:{" DFC11.k1P STATE:O(- ZIP:a172Q3 CITY: STATE: ZIP: AUGPHONE#1: I44Z J I-464i PHONE: CELL: U 2 5 2023
PHONE#2: q07-299-4-0o EMAIL:
EMAIL:,,CAR-pLNT'LR 14 81.03Ma11,caA,tr. L&I REG# EXP. / / RECEIVED
PRIMARY CONTACT: OWNER CONTRACTOR❑ OTHER❑
NAME JESSE. CilZe�IJTE.1- EMAIL J . CAlePt.1%.>"1"EL I. egrr�l) C-arr�
MAILING ADDRESS g�(t N.) D1 14 ST CITY PorGTL.�cr)D STATE OK- ZIP -4-7-0'3
PHONE S I4-42.1 CELL ?Ili-421-45 1
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 3223 1 — 44-- 000(00 ZONING 'l-5
LEGAL DESCRIPTION(Abbreviated) TR Co OF S£ SE FIRE DISTRICT
SITE ADDRESS X)(X G SKIM I EN De. T b.J' - CITY LI N/I ON
DIRECTIONS TO SITE ADDRESS 1-KOM E. LAM ON 1:1 L�t R D, '1 A RN K I C�-i-t1 ow-to E.
,smVdw R• PROcxi-L 7+->;ZouG(I 1,14LCCIc GA-[F. To END of RDt?OiP (4{ O'J
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES, NO❑ SNOW LOAD: 2S psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check au that apply)
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF 0 STREAM❑
TYPE OF WORK: NEW, ADDITION 0 ALTERATION 0 REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg Etc.) KE<SID iJLE
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS I NUMBER OF BATHROOMS I
HEATED STRUCTURE? YES(Whole Bldg)SP YES(Fowls]of Bldg)0 NO❑
DESCRIBE WORK
SQUARE FOOTAGE:(proposed)
1ST FLOOR (o1S sq.ft. 2ND FLOOR i}-4.I sq.ft. 3RD FLOOR sq.ft. BASEMENTS- sq.ft.
DECK sq.ft. COVERED DECK) sq.ft. STORAGE sq.ft. OTHER sq.ft.
GARAGE / sq.ft. Attached 0 Detached❑ CARPORT sq.ft. Attached 0 Detached 0
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❑ / NEW la EXISTING❑
PLUMBING IN STRUCTURE? YES, NO❑ If yes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NON EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 1 TOTAL BEDROOMS 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&void if work or authorized construction is not commenced within 180
days or it 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
P MIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08.42)
X o8` 1 7-0 .3
S nature of OWNER(Must be signed by the OWNER) Date
EPARTIv1ENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BL G DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL '�I,_,,-,(+ (�j,,
PUBLIC HEALTH X '4,�'�j� C 0 U` (h`ok Cza`°"'�-Prc
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