HomeMy WebLinkAboutBLD2023-01183 - BLD CD Environmental Health Review - 10/5/2023 Permit N In ?
MASON COUNTY lip EIVEDj
COMMUNITY DEVELOPMEN
Permit Assistance Center,Building,Planning PCT 2 2023
BUILDING PERMIT APPLICATION 615 . Ider Street)
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME:BARBAM SM"a DONALD EWING NAME:
MAILING ADDRESS:M NW 43M ST MAILING ADDRESS:
CITY:SFATiHE STATE:WA ZIP:gamy CITY: STATE:_ZIP:
PHONE#I:�18 PHONE: CELL: y
PHONE#2: EMAIL:
EMAIL:ellxon.ewirga®gma.wm L&I REG# EXP•—/
PRIMARY CONTACT: OWNER D CONTRACTOR❑ OTHER❑ LLI
NAME scorrcwasExlaoeEm HurcHlaox AnclmECTuaEI EMAIL sooa®'obhuldnaminown
MAILING ADDRESS 4oto WHITMAN AYE N CITY aEATRE STATE WA ZIP !1
PHONE 2 lty CELL slaM"a1
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Nu nber) -M45000014 ZONING RR-5
LEGAL DESCRIPTION(Abbreviated) SOUTHERN PU SOUND FARMS FIRE DISTRICT 5
SITE ADDRESS Ogg E uBBY RD CITY SHaT1ON,WASB594
DIRECTIONS TO SrrE ADDRESS e"e®LOVi�wersr�m.raiwawesuneFwrreaarsrmwwmeeosw wuseavarrae*.rxsensuwcFne®^"
paNEWAYONTIEHFSTaIDECFEU ffaOM.
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14•k: YES[] NO Q+ SNOW LOAD:225 ad
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Chackull drmlgply):
SALTWATER 0r LAKE❑ RIVER/CREEK❑ POND❑ WETLAND 0 SEASONALRUNOFF ❑ STREAM Qi
TYPE OF WORK: NEw p ADDITION❑ ALTERATION❑ REPAIR❑ OTHER ❑
USE OF STRUCTURE(B dwaa,Gowga cwwa.eal BWs,arc)RESIDENCE
IS USE: PRIMARY 0 SEASONAL❑ NUMBER OF BEDROOMS 1 NUMBER OF BATHROOMS
HEATED STRUCTURE? YES(while BWgl 0+ YES(Pmt[,j olBlog) ❑ NO❑
DESCRIBE WORK DEMOLRION OFAN(E)BARN STRUCTURE ON Sf1E.CONSTRUCTION OF A(N)PRIMARY RESIDENCE.
SOUARE FOOTAGE: (propoaul
IST FLOOR 1797 sq.ft. 2ND FLOOR D sq.ft. 3RD FLOOR D sq.ft. BASEMENT D sq.ft.
DECK 105 Sq.ft. COVERED DECK m sq.fL STORAGE D sq.R OTHERD sq.ft.
GARAGE g sq.ft. Attached❑ Detached❑ CARPORT D sq.8 Attached❑ Detached❑
mANLTFACrjWajraNm INFO a4 COPIES OF THE FLOOR PLAN REQUIRED*
MODEL' - LENGTH-
TH- BEDROOMS- BATHS- SERIAL NUMBER'
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTING 0
PLUMBING IN STRUCTURE? YES Q+ NO❑ Ijyes,attach completed Water Adequacy Form
PERRgTER/FO=T1RTAJNS PRO�SED?S YES ❑ NO I EXISTING SQ.FT. D
(:PebIr% n 0
EXISTING BEDROOMS ' PROPOSED BEDROOMS 1 TOTAL BEDROO
OYMER acknowledges Nat submission of inaccurate irdmmation may result in a stop work order or permit revocatan.A nowledgament of such a by
signature below.I declare that I am the owner and I further declare that I am entillad to receive this permit and to do the work as proposed.I have
obtained pemission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal
representative,represents that the inforrnatem provided is accurate and grants employees of Mason County access to the abowH described property
and etmclure(s)for review and inspection. This pennMapplicagon becomes null S voN If work or authonae l construction M not commenced within 180
days or a construction work M suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
P PLICATION OF 100 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.08A2)
Signature of OWNER(Must be stalled by me OWNER' Dale
n
REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
TMENTTMENT D
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