HomeMy WebLinkAboutBLD2023-01163 - BLD CD Environmental Health Review - 10/3/2023 Z03
Per IS No:1td 'Ib Al- 61 1MASON COUNTY 13 RECEIVEDCOMMUNITY DEVET
Permit Assistance Center,Building,Planning btr 2 ( 2023 G
BUILDING PERMIT APPLICATION 615 W. Alder Street
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: le'o Q/n G )Qk NAME
MAILING ADDRESS: MAILIN ADD�G RESS:
CITY: STATE: G)A- ZIP: 914z2 CITY: __,_ STATE:, ZIP: _ r-
PHONE#I: 2Ly — -74gf PHONE: , CELL: : _
PHONE#2: EMAIL '- I __
EMAII.: L&I REG# EXP.
PRIMARY CONTACT: OWNER❑ CONTRACTOR Q� R 1
NAME _ niil OLIM1NK EMAIL /Jy0.NI�d9Z 4alJOD,GCNr
MAILINGA^DDRESS 21OU �R 5+ CITY STATEwill, zip 9�'Sgl
PHONE d S 31 -JOQ 6'1OQ CELL
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) 3 2/Q �4— 0065 ZONING
LEGAL DESCRIPTIOO (Abbreviated) FIRE DISTRICT
SITE ADDRESS 9 F 9/ ode z CTrY (Zn1m
e
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NOP SNOW LOAD:_pat
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Cfuckaildutayply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM
TYPE OF WORK: NEW-9 ADDITION❑ ALTE�RnATION ❑ REPAIR❑ OTHER ❑ In
USE OF STRUCTURE J(Beaiderme,Garage,Commercial B14q,E0 'W 5t�C.e
IS USE: PRIMARY 19 SEASONAL❑ NUMBER OF BEDROOMS_ NUMBER OF BATHROOMS [A
HEATED STRUCTURE? YES`(uhok Bldg)® YES(Part[,) s`Bdg1❑ NO❑ , O
DESCRIBE WORK UI't�( G Sj M"
SOUARE FOOTAGE: (spored
1ST FLOOR_t6L7sq.ft. 2ND FLOOR sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft. I s
DECK sq.ft. COVERED DECK—La sq.ft. STORAGE sq.k OTHER sq.ft.
GARAGE f/fO sq.ft. Attached)(Detached❑ CARPORT sq.ft. Attached❑ Detached❑
MANUFACTURED HOME INFORMATION: e4 COPIES OF THE FLOOR PLAN REQUIRED"
-----------------
MAKE MOD YEAR LENGTH
WID BEDROOMS BATHS NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC-9 SEWER / NEW EXISTING❑
PLUMBING IN STRUCTURE? YES NO ❑ Ifyer, attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YES❑ NO[] EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS - 3 TOTAL BEDROOMS_
OWNER acknowledges that submission of inaccurate information may result in a stop work order or peen@ revocation.Acknowledgement
of such isby
signature below. I declare that I sm the miner 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
reoresentaf ke.rameseras that the infornatian provided is accurete and arares emolovees of Mason Counts access to the above descdbetl oroceM
z �
Ux
oo� \
S _!£ ; § as
SL
$ii y
\\ k y -
<
7 }` 10., ; \
) /
! § % 14, ~ , »
o/ /
| % | j j TRI-TO | /